Cargando…

Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation

BACKGROUND: Infections represent one of the most common complications in patients managed on Extracorporeal Membrane Oxygenation (ECMO) and are associated with poorer outcomes. Clinical signs of infection in patients on ECMO are non-specific. We assessed the diagnostic accuracy of Procalcitonin (PCT...

Descripción completa

Detalles Bibliográficos
Autores principales: Doo, Irene, Staub, Lukas P., Mattke, Adrian, Haisz, Emma, Seidler, Anna Lene, Alphonso, Nelson, Schlapbach, Luregn J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826436/
https://www.ncbi.nlm.nih.gov/pubmed/35155322
http://dx.doi.org/10.3389/fped.2021.824552
_version_ 1784647432952348672
author Doo, Irene
Staub, Lukas P.
Mattke, Adrian
Haisz, Emma
Seidler, Anna Lene
Alphonso, Nelson
Schlapbach, Luregn J.
author_facet Doo, Irene
Staub, Lukas P.
Mattke, Adrian
Haisz, Emma
Seidler, Anna Lene
Alphonso, Nelson
Schlapbach, Luregn J.
author_sort Doo, Irene
collection PubMed
description BACKGROUND: Infections represent one of the most common complications in patients managed on Extracorporeal Membrane Oxygenation (ECMO) and are associated with poorer outcomes. Clinical signs of infection in patients on ECMO are non-specific. We assessed the diagnostic accuracy of Procalcitonin (PCT), C-reactive protein (CRP) and White cell count (WCC) to diagnose infection on ECMO. METHODS: Retrospective single center observational study including neonates and children <18 years treated with ECMO in 2015 and 2016. Daily data on PCT, CRP and WCC were assessed in relation to microbiologically confirmed, and clinically suspected infection on ECMO using operating characteristics (ROC) curves. RESULTS: Sixty-five ECMO runs in 58 patients were assessed. CRP had the best accuracy with an area under the ROC curve (AUC) of 0.79 (95%-CI 0.66–0.92) to diagnose confirmed infection and an AUC of 0.72 (0.61–0.84) to diagnose confirmed and suspected infection. Abnormal WCC performed slightly worse with an AUC of 0.70 (0.59–0.81) for confirmed and AUC of 0.66 (0.57–0.75) for confirmed and suspected infections. PCT was non-discriminatory. CONCLUSION: The diagnosis of infections acquired during ECMO remains challenging. Larger prospective studies are needed that also include novel infection markers to improve recognition of infection in patients on ECMO.
format Online
Article
Text
id pubmed-8826436
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-88264362022-02-10 Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation Doo, Irene Staub, Lukas P. Mattke, Adrian Haisz, Emma Seidler, Anna Lene Alphonso, Nelson Schlapbach, Luregn J. Front Pediatr Pediatrics BACKGROUND: Infections represent one of the most common complications in patients managed on Extracorporeal Membrane Oxygenation (ECMO) and are associated with poorer outcomes. Clinical signs of infection in patients on ECMO are non-specific. We assessed the diagnostic accuracy of Procalcitonin (PCT), C-reactive protein (CRP) and White cell count (WCC) to diagnose infection on ECMO. METHODS: Retrospective single center observational study including neonates and children <18 years treated with ECMO in 2015 and 2016. Daily data on PCT, CRP and WCC were assessed in relation to microbiologically confirmed, and clinically suspected infection on ECMO using operating characteristics (ROC) curves. RESULTS: Sixty-five ECMO runs in 58 patients were assessed. CRP had the best accuracy with an area under the ROC curve (AUC) of 0.79 (95%-CI 0.66–0.92) to diagnose confirmed infection and an AUC of 0.72 (0.61–0.84) to diagnose confirmed and suspected infection. Abnormal WCC performed slightly worse with an AUC of 0.70 (0.59–0.81) for confirmed and AUC of 0.66 (0.57–0.75) for confirmed and suspected infections. PCT was non-discriminatory. CONCLUSION: The diagnosis of infections acquired during ECMO remains challenging. Larger prospective studies are needed that also include novel infection markers to improve recognition of infection in patients on ECMO. Frontiers Media S.A. 2022-01-26 /pmc/articles/PMC8826436/ /pubmed/35155322 http://dx.doi.org/10.3389/fped.2021.824552 Text en Copyright © 2022 Doo, Staub, Mattke, Haisz, Seidler, Alphonso and Schlapbach. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Doo, Irene
Staub, Lukas P.
Mattke, Adrian
Haisz, Emma
Seidler, Anna Lene
Alphonso, Nelson
Schlapbach, Luregn J.
Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation
title Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation
title_full Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation
title_fullStr Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation
title_full_unstemmed Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation
title_short Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation
title_sort diagnostic accuracy of infection markers to diagnose infections in neonates and children receiving extracorporeal membrane oxygenation
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826436/
https://www.ncbi.nlm.nih.gov/pubmed/35155322
http://dx.doi.org/10.3389/fped.2021.824552
work_keys_str_mv AT dooirene diagnosticaccuracyofinfectionmarkerstodiagnoseinfectionsinneonatesandchildrenreceivingextracorporealmembraneoxygenation
AT staublukasp diagnosticaccuracyofinfectionmarkerstodiagnoseinfectionsinneonatesandchildrenreceivingextracorporealmembraneoxygenation
AT mattkeadrian diagnosticaccuracyofinfectionmarkerstodiagnoseinfectionsinneonatesandchildrenreceivingextracorporealmembraneoxygenation
AT haiszemma diagnosticaccuracyofinfectionmarkerstodiagnoseinfectionsinneonatesandchildrenreceivingextracorporealmembraneoxygenation
AT seidlerannalene diagnosticaccuracyofinfectionmarkerstodiagnoseinfectionsinneonatesandchildrenreceivingextracorporealmembraneoxygenation
AT alphonsonelson diagnosticaccuracyofinfectionmarkerstodiagnoseinfectionsinneonatesandchildrenreceivingextracorporealmembraneoxygenation
AT schlapbachluregnj diagnosticaccuracyofinfectionmarkerstodiagnoseinfectionsinneonatesandchildrenreceivingextracorporealmembraneoxygenation