Prediction Of Neutrophil Alkaline Phosphatase For Different Bacterial Infections

1.ObjectiveTo investigate the relationship between neutrophil alkaline phosphatase(NAP)and neutrophil Alkaline phosphatase infection,such as procalcitonin(PCT),C-reactive protein(CRP)and white blood cell count(WBC),to assess the predictive value of neutrophil Alkaline phosphatase for Gram-positive bacteria and Gram-negative bloodstream infections.2.MethodsOne hundred and thirty-one blood culture-positive patients admitted to the Department of Emergency Medicine,University Affiliated Hospital of Dalian Medical University from January 1,2018 to November 1,2022 were selected as the observation objects.The blood culture results of the patients were divided into gram-positive bacterial blood flow infection group(n=68),gram-negative bacterial blood flow infection group(n=63),and the patients confirmed as non-bacterial blood flow infection were selected as the control group(n=70).Collect the general data,medical history,pathogenic bacteria types of blood flow infection after admission,and record the levels of NAP,PCT,CRP and WBC after admission.Compare the levels of NAP,PCT,CRP and WBC after admission in three groups of patients,and analyze the sensitivity,specificity,and 95CI%of the best critical value of identifying gram-positive bacterial blood flow infection and gram-negative bacterial blood flow infection,and calculate the area under the curve using the ROC curve,Select the best critical value corresponding to the maximum Jordan index,analyze the differential diagnosis value of NAP positive rate and NAP positive score for different bacterial blood flow infections,and compare them with PCT,CRP and WBC.The data in this study were analyzed by SPSS 26.0software.When P<0.05,it was considered statistically significant.3.Results(1)General data comparisonThere were no significant differences in gender and age among the three groups of patients with Gram-positive bacterial bloodstream infection group,Gram-negative bacterial bloodstream infection group and non-bacterial bloodstream infection group(P>0.05).(2)Comparison of NAP positivity rate and NAP positivity score1)There was no statistical significance in the positive rate and score of NAPbetween G-infection group and control group(P>0.05).2)The positive score level of NAP in G-infection group[94(83,142)]wassignificantly higher than that in G+infection group[72(27.25,137.5)],and the difference was statistically significant(P<0.01).3)The positive score level of NAP in G-group[94(83,142)]was significantlyhigher than that in control group[42(29.5,73.5)],and the difference was statistically significant(P<0.01).(3)ROC CurveBy drawing the ROC curve,the cutoffs corresponding to the maximal Jordan index were obtained:the Nap Positive Integral had an area under the curve of 0.768(95%CI:0.680-0.856)for distinguishing Gram-negative bloodstream infection from the maximal Jordan index in the control group,the optimal diagnostic cut-off value was 74,the highest sensitivity were 85.7%and the specificity was 48.1%.By drawing ROC curve,when NAP positive rate>18.5%,NAP positive score>77.5,CRP>46.99mg/L,PCT>1.61ng/L,WBC>10.39×10~9/L as the critical value,The sensitivity of differential diagnosis of Gram-positive and gram-negative bacterial infections were 57.1%,85.7%,49.2%,84.1%and 57.1%,respectively.The specificity was 72.9%,75.7%,98.6%,67.1%,94.3%.4.Conclusion(1)The NAP positive score of the Gram-negative bloodstream infection group was higher than that of the Gram-positive bacteria bloodstream infection group.(2)NAP positive score may be a useful index for differential diagnosis of Gram-negative bloodstream infection,and its differential diagnostic value is superior to PCT,CRP and WBC.