Background: This study was performed to investigate the combination of admission serum procalcitonin (PCT) and albumin (alb) concentrations as a diagnostic predictor for discriminating patients with nosocomial blood stream infection (BSI) among those with spontaneous intra-cerebral hemorrhage (ICH). Methods: We conducted a retrospective study on patients with ICH and hospital-acquired BSI. Clinical and microbiological data were compared in patients who experienced nosocomial BSI during a hospital stay and those who did not. Multivariable logistic regression analyses were used to identify independent risk factors for nosocomial BSI. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of the albumin:PCT ratio. Results: Patients with nosocomial BSI had lower albumin:PCT ratios than those without BSI (11.739 [3.192-38.452] versus 200.000 [40.634-417.500]; p < 0.001). Multivariable logistic regression analysis revealed that the albumin:PCT ratio (odds ratio [OR] 1.006; 95% confidence interval [CI] 1.002-1.011; p = 0.001], white blood cell count (OR 1.129; 95% CI 1.044-1.220; p = 0.002), and shock (OR 4.504; 95% CI 1.774-11.435; p = 0.002) were independent predictors of nosocomial BSI, allowing distinction of patients with the infection from those without. The area under the ROC curve for the albumin:PCT ratio was 0.830 (95% CI 0.768-0.892; p < 0.001). The cut-off value of the albumin:PCT ratio was <1.087 with a sensitivity of 90.6% and a specificity of 98.8%. In the subgroup of 85 patients with nosocomial BSI, the albumin:PCT ratio in patients with shock was lower than that in those without shock (7.154 [2.975-26.267] vs 28.000 [3.818-57.812]; p = 0.027). Conclusion: The albumin:PCT ratio can be used as an early diagnostic predictor for nosocomial BSI in patients with ICH. Additionally, BSI patients with lower albumin:PCT ratios are more likely to experience shock. The albumin:PCT ratio is expected to be a rapid and low-cost tool for clinical practice.

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