Anemia measurements to distinguish between viral and bacterial infections in the emergency department
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The clinical diagnosis of acute infections in the emergency department is a challenging task due to the similarity in symptom presentation between virally and bacterially infected individuals, while the use of routine laboratory tests for pathogen identification is often time-consuming and may contain contaminants. We investigated the ability of various anemia-related parameters, including hemoglobin, red cell distribution width (RDW), and iron, to differentiate between viral and bacterial infection in a retrospective study of 3883 patients admitted to the emergency department with a confirmed viral (n = 1238) or bacterial (n = 2645) infection based on either laboratory tests or microbiological cultures. The ratio between hemoglobin to RDW was found to be significant in distinguishing between virally and bacterially infected patients and outperformed other anemia measurements. Moreover, the predictive value of the ratio was high even in patients presenting with low C-reactive protein values (< 21 mg/L). We followed the dynamics of hemoglobin, RDW, and the ratio between them up to 72 h post emergency department admission, and observed a consistent discrepancy between virally and bacterially infected patients over time. Additional analysis demonstrated higher levels of ferritin and lower levels of iron in bacterially infected compared with virally infected patients. The anemia measurements were associated with length of hospital stay, where all higher levels, except for RDW, corresponded to a shorter hospitalization period. We highlighted the importance of various anemia measurements as an additional host-biomarker to discern virally from bacterially infected patients.
KeywordsEmergency department Anemia Red cell distribution width Viral infection Bacterial infection C-reactive protein
This work was financially supported by the Israel Science Foundation Grant 288/16 (YS and IG-V). Partial fellowships were from the European Research Council (637885), the Edmond J. Safra Center for Bioinformatics at Tel Aviv University (YS), and a Shulamit Aloni Scholarship (YS). IG-V is a Faculty Fellow of the Edmond J. Safra Center for Bioinformatics at Tel Aviv University. S.S.T and A.M were financially supported by the ELROV grant.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Ethical approval and inform consent
The study was reviewed and approved by the Tel-Aviv medical center institutional Helsinki Committee (number 0491-17). Study participants gave their written informed consent for participation according to the instructions of the local ethics committee.
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