PREDICTORS OF POSITIVE BLOOD CULTURE IN PATIENTS WITH SUSPECTED SEPSIS IN THE EMERGENCY DEPARTMENT: DEVELOPMENT OF THE ED-CBS AND ED-PRO SCORES
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Abstract
Objective: To identify factors associated with blood culture positivity and to develop the ED-CBS and ED-Pro scoring models for risk stratification in patients with suspected sepsis presenting to the emergency department.
Patients and Methods: This retrospective analytical study included 185 adults who underwent blood culture sampling in 2025. Independently associated factors were identified using multivariable logistic regression, and discriminatory performance was evaluated using ROC analysis. ED-CBS incorporated NLR, platelet count, and CRP, whereas ED-Pro incorporated NLR, platelet count, and procalcitonin. Internal validation was performed using bootstrap resampling and 5-fold cross-validation.
Results: Blood cultures were positive in 27.0% of patients. The positive group had significantly higher NLR, PCT, CRP, SOFA score, and creatinine, and lower platelet count (all p<0.05). NLR and procalcitonin showed the highest individual AUCs, both 0.736. In multivariable analysis, NLR ≥15 and a urinary source of infection were independently associated with blood culture positivity. ED-CBS and ED-Pro achieved AUCs of 0.772 and 0.789, respectively. Bootstrap and cross-validation AUCs were 0.765 and 0.758 for ED-CBS and 0.783 and 0.778 for ED-Pro. Blood culture positivity increased from 8.3% among patients with ED-Pro scores of 0–1 to 90.9% among those with a score of 5.
Conclusions: In patients with suspected sepsis presenting to the emergency department, NLR ≥15 and a urinary source of infection were independently associated with blood culture positivity. ED-CBS and ED-Pro demonstrated acceptable and relatively stable discrimination during internal validation but require external validation before widespread use.
Keywords
bacteremia, sepsis, blood culture, emergency department, neutrophil-to-lymphocyte ratio, procalcitonin, prediction model
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References
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