5% PPV. Statistical significance was also found for LBP with higher values in patients with bacteremia compared to patients without bacteremia (23.0 vs. 30.4 pg/ml, p = 0.003). The ROC-AUC for LBP was 0.62 with 61.6% sensitivity, 62.3% specificity, 83.0% NPV, and 35.2% PPV. No significant differences were assessed in IL-6, CRP, or WBC (table 5). Discussion In patients with SIRS, selleck chem detection of infection is crucial for proper management. Since there is a lack of accurate, rapid and cost efficient diagnostic tools for the identification of septic patients, physicians are regularly faced with resulting uncertainties [22]. Moreover, there is major variation in the host��s immune response. The spectrum of the host��s immune response ranges from immunoparalysis to hyperinflammation, partly independent of the expansion of the infectious focus.

Therefore, the robustness of biomarkers is pivotal for their applicability in the everyday routine [23,24]. The IPS and various sepsis biomarkers have been shown to be beneficial in the identification of infection, although the data on its clinical utility is controversial. Most studies have been conducted in critical care patients with severe disease or at emergency departments, but evaluation in standard care patients with an appropriate pre-selection in order to focus on relevant patients has rarely been performed. In addition, in the majority of studies outcome parameters were based on discharge diagnosis rather than on well evaluated and reproducible criteria.

Due to the absence of a real gold standard and a lack of an applicable SIRS classification system, surveys on patients with suspected infection are challenging. In the present study, 2,384 standard care patients with clinical suspicion of infection were consecutively screened for the occurrence of SIRS. To obtain a relevant study population, only patients with SIRS were included. IPS and sepsis biomarkers were evaluated regarding their potency to differ between SIRS patients with infection and those with SIRS due to other causes. Furthermore, the capacity to identify SIRS patients with bacteremia was assessed. Infection as the main outcome parameter was defined according to an established and robust protocol [21]. In order to minimize false positive blood culture results, patients with a possible contaminant in their blood culture and an unclear infectious focus were excluded [19,20].

Regarding the differentiation of SIRS patients with infection from those with systemic inflammation due to other reasons, the diagnostic ability of the IPS and sepsis biomarkers was poor in the present study. In fact, the IPS was developed as an infection AV-951 score in severely ill patients, for which Bota et al. have shown a high NPV (89.5%) to exclude infections [11]. Likewise, other initial evaluations in severely ill patients as well as in hemato-oncological patients were promising [25,26].