Relationship of C-reactive Protein/Serum Albumin Ratio and qPitt Bacteremia Score With An All-Cause In-Hospital Mortality in Patients With Bloodstream Infections.

Background: Bloodstream infections remain a major cause of morbidity and mortality despite notable advances in their diagnosis and treatment. C-reactive protein/serum albumin ratio and the quick Pitt bacteremia score are two useful tools for clinicians to assess severity and predict mortality risk in patients with sepsis attributable to bloodstream infections. This study examined the relationship between C-reactive protein/serum albumin ratio and Q Pitt bacteremia score with all-cause in-hospital mortality in patients with bloodstream infections.
Methods: Hospitalized adult patients with bacteremic bloodstream infections between January 1, 2020, and December 31, 2021, were retrospectively reviewed. Patients' demographics and clinical and laboratory data were retrieved from patient electronic records. C-reactive protein/albumin ratio was calculated using CRP (mg/L) and serum albumin (g/L) values obtained within 24 hours of blood culture collection and quick Pitt bacteremia score was calculated for each patient with each of the five variables of the score determined within 24 hours of blood culture collection and each patient was assigned a numerical score of 0-5 accordingly. The relationship between C-reactive protein/albumin ratio and quick Pitt bacteremia score with all-cause in-hospital mortality was determined.
Results: A total of 187 hospitalized adult patients with non-repeat bacteremic bloodstream infections were identified.  Escherichia coli  was the most common Gram-negative blood isolate while  Staphylococcus aureus  was the predominant Gram-positive isolate. One hundred and five (56.1%) patients were male with a cohort mean age of 56.9 ± 2.7 years. All-cause in-hospital mortality was 27.3%. The mean CRP/albumin ratio (8.6 ±1.7) and mean quick Pitt bacteremia score (2.8 ±0.4) were significantly higher in patients with bloodstream infections who died during their hospitalization compared to those who survived. The all-cause in-hospital mortality was 8%, 12%, 22%, 46%, 93%, and 100% for patients with quick Pitt scores of 0, 1, 2, 3, 4, and 5, respectively.
Conclusion: In hospitalized patients with bacteremic bloodstream infections, an incremental increase in quick Pitt bacteremia score and mean C-reactive protein/albumin ratio of >8 was associated with higher mortality.
Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Medical Research and Ethics Committee, College of Medicine and Health Sciences, Sultan Qaboos University issued approval MREC#2745. TO: Dr. Abdullah Balkhair Principal Investigator, Department of Medicine Sultan Qaboos University Hospital SUBJECT: Approval of the Research Project REF. NO. SQU-EC/ 100/2022 MREC # 2745 “Correlation of C-reactive protein/serum albumin ratio and Q Pitt bacteremia score with 14day mortality in patients with bloodstream infections” Date: 30th May 2022 I am pleased to inform you that the above mentioned research project submitted to the Medical Research Ethics Committee (MREC), College of Medicine and Health Sciences, Sultan Qaboos University for review and approval was discussed during its meeting of 26th May 2022. The Committee has considered your research project acceptable and therefore approval is granted. I wish you a productive study with your research work. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
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