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Serum protein electrophoresis: an interesting diagnosis tool to distinguish viral from bacterial community-acquired pneumonia

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Abstract

29-69 % of pneumonias are microbiologically documented because it can be considered as an invasive procedure with variable test sensitivity. However, it drastically impacts therapeutic strategy in particular the use of antibiotics. Serum protein electrophoresis (SPEP) is a routine and non-invasive test commonly used to identify serum protein disorders. As virus and bacteria may induce different globulins production, we hypothesize that SPEP can be used as an etiological diagnosis test. Retrospective study conducted from 1/1/13 until 5/1/15 among patient hospitalized for an acute community-acquired pneumonia based on fever, crackles and radiological abnormalities. α/β, α/γ, β/γ globulins and albumin/globulin (A/G) ratio were calculated from SPEP. Data were analyzed in 3 groups: documented viral (DVP) or bacterial pneumonia (DBP) and supposedly bacterial pneumonia (SBP). We used ANOVA statistic test with multiple comparisons using CI95 and ROC curve to compare them. 109 patients included divided into DBP (n = 16), DVP (n = 26) and SBP (n = 67). Mean age was 62 ± 18 year-old with a sex ratio M/F of 1.3. Underlying conditions (e.g. COPD, diabetes) were comparable between groups in multivariate analysis. Means of A/G ratio were 0.80 [0.76-0.84], 0.96 [0.91-1.01], 1.08 [0.99-1.16] respectively for DBP, SBP and DVP (p = 0.0002). A/G ratio cut-off value of 0.845 has a sensitivity of 87.5 % and a specificity of 73.1 %. A/G ratio seems to be an easy diagnostic tool to differentiate bacterial from viral pneumonia. A/G ratio cut-off value below 0.845 seems to be predictable of a bacterial origin and support the use of antibiotics.

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Acknowledgments

This work was presented orally in part at the 55th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA, USA, September 18 2015.

The authors thank the Raymond Poincaré Teaching Hospital and Infectious Diseases Colleagues Anne-Claude Crémieux and Azzam Salrh-Mghir for their support, and Clara Duran for proofreading.

I confirm that all listed authors have contributed to this work and approved the paper. This manuscript also fulfils the ethics committee approval.

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Authors and Affiliations

  1. Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches, France

    B. Davido, C. Badr, A. Lagrange, S. Makhloufi, P. De Truchis, C. Perronne, J. Salomon & A. Dinh

  2. Infectious Diseases Department, Raymond Poincaré Teaching Hospital, Garches, 92380, France

    B. Davido

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  1. B. Davido
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  2. C. Badr
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  3. A. Lagrange
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Correspondence to B. Davido.

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This study was carried out as part of our routine work.

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The authors declare that they have no conflict of interest.

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As part as routine care, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Davido, B., Badr, C., Lagrange, A. et al. Serum protein electrophoresis: an interesting diagnosis tool to distinguish viral from bacterial community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 35, 899–902 (2016). https://doi.org/10.1007/s10096-016-2613-0

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  • DOI: https://doi.org/10.1007/s10096-016-2613-0

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