title: The intensive care infection score - a novel marker for the prediction of infection and its severity.
abstract: The prediction of infection and its severity remains difficult in the critically ill. A novel, simple biomarker derived from five blood-cell derived parameters that characterize the innate immune response in routine blood samples, the intensive care infection score (ICIS), could be helpful in this respect. We therefore compared the predictive value of the ICIS with that of the white blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT) for infection and its severity in critically ill patients.
  
  
  
  We performed a multicenter, cluster-randomized, crossover study in critically ill patients between January 2013 and September 2014. Patients with a suspected infection for which blood cultures were taken by the attending intensivist were included. Blood was taken at the same time for WBC, ICIS, CRP and PCT measurements in the control study periods. Results of imaging and cultures were collected. Patients were divided into groups of increasing likelihood of infection and invasiveness: group 1 without infection or with possible infection irrespective of cultures, group 2 with probable or microbiologically proven local infection without blood stream infection (BSI) and group 3 with BSI irrespective of local infection. Septic shock was assessed.
  
  
  
  In total, 301 patients were enrolled. CRP, PCT and ICIS were higher in groups 2 and 3 than group 1. The area under the receiver operating characteristic curve (AUROC) for the prediction of infection was 0.70 for CRP, 0.71 for PCT and 0.73 for ICIS (P < 0.001). For the prediction of septic shock the AUROC was 0.73 for CRP, 0.85 for PCT and 0.76 for ICIS. These AUROC did not differ from each other.
  
  
  
  The data suggest that the ICIS is potentially useful for the prediction of infection and its severity in critically ill patients, non-inferiorly to CRP and PCT. In contrast to CRP and PCT, the ICIS can be determined routinely without extra blood sampling and lower costs, yielding results within 15 minutes.
  
  
  
  ClinicalTrials.gov identifier: ID NCT01847079 . Registered on 24 April 2013.
authors.affiliation: Department of Intensive Care Medicine of the Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands. p.vandergeest@erasmusmc.nl.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: van der Geest
authors.affiliation: Department of Intensive Care Medicine of the Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Mohseni
authors.affiliation: Faculty of Health Science, University of Medicine, Institute of Immunology, University Witten/Herdecke, Witten, Germany.
authors.forename: Jo
authors.initials: J
authors.lastname: Linssen
authors.affiliation: Department of Intensive Care Medicine of the Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Servet
authors.initials: S
authors.lastname: Duran
authors.affiliation: Department of Clinical Chemistry of the Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: de Jonge
authors.affiliation: Department of Intensive Care Medicine of the Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis* / Q000097:blood; D000071997:Blood Culture; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000032:analysis / Q000097:blood; D016009:Chi-Square Distribution; D016638:Critical Illness / Q000628:therapy; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood / Q000175:diagnosis*; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D018805:Sepsis / Q000097:blood / Q000175:diagnosis; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Biomarkers; Critically ill; ICIS; Infection; PCT; Septic shock