A Prediction Score Versus Procalcitonin and Presepsin for Predicting Bacteremia in the Emergency Department: A Single-Center Retrospective Cohort Study

Background/Objectives: Early prediction of bacteremia is clinically important in the emergency department (ED). We previously developed a prediction score using vital signs and routine blood tests. Whether procalcitonin (PCT) or presepsin (PSEP), biomarkers of bacterial infection, outperform this score for predicting bacteremia remains unclear. This study aimed to compare the predictive performance of the prediction score with PCT and PSEP for bacteremia in the ED. Methods: This single-center, retrospective cohort study included patients aged ≥16 years with suspected bacteremia in the ED between April 2020 and March 2021. The period was divided based on biomarker measured: Period 1 (PCT) and Period 2 (PSEP). The prediction score was compared with PCT within Period 1 and with PSEP within Period 2. Predictive performance for bacteremia was compared using the area under the receiver operating characteristic curve (AUC), and clinical utility was assessed by decision curve analysis (DCA). Results: Of 2922 patients (1539 in Period 1; 1383 in Period 2), the AUCs of the prediction score and PCT in Period 1 were 0.76 and 0.79 (p = 0.075). In Period 2, the score’s AUC (0.75) was significantly higher than PSEP’s (0.70, p = 0.013). DCA showed substantial net benefit for the score, with marginal incremental benefit from adding PCT or PSEP. Conclusions: A prediction score based on vital signs and routine blood tests showed predictive performance comparable to PCT and superior to PSEP for predicting bacteremia in the ED.