Nomogram-based analysis of plasma albumin and C-reactive protein 30 days before bloodstream infection for 30-day mortality in Singapore and Denmark

This study aimed to assess the prognostic impact of plasma albumin (PA) and C-reactive protein (CRP), measured up to 30 days before a bloodstream infection (BSI), on 30-day mortality risk using nomogram models. Two cohorts comprising 5,221 inpatients from Singapore (SG) and 15,710 from Denmark (DK) with first-time BSIs were included from 2006 to 2016. Using multivariable logistic regression models, we analyzed the association between CRP and PA measured at different time-points (segmented into 5-day intervals, up to 30 days before the day of BSI (D0), and on D0) and 30-day mortality. Moreover, nomogram models assessed the relative attributions of PA and CRP to 30-day mortality risk. Both cohorts had similar 30-day mortality rates (SG: 17.4%, DK: 20.2%). Correlation coefficients between PA on D0 and PA in all 5-day intervals were high (range: 0.55/0.75) whereas it was only high between CRP on D0, and CRP measured 1-5 days before D0. In nomogram models, PA contributed most to the prognostic predictability (from 20 to 55%) whereas CRP contributed little (from 0.5 to 9%) regardless of time interval from D0. Albumin, measured up to 30 days before a BSI episode, was a strong prognosticator of 30-day mortality. Nomogram models enable rapid evaluation of a patient's prognosis.