Details

Autor(en) / Beteiligte

• Pieri, Marina, MD
• Greco, Teresa, MSc
• De Bonis, Michele, MD
• Maj, Giulia, MD
• Fumagalli, Luca, MD
• Zangrillo, Alberto, MD
• Pappalardo, Federico, MD

Titel

Diagnosis of infection in patients undergoing extracorporeal membrane oxygenation: A case-control study

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2012-06, Vol.143 (6), p.1411-1416.e1

Ort / Verlag

New York, NY: Mosby, Inc

Erscheinungsjahr

2012

Link zum Volltext

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Objective Diagnosis of infection in patients receiving extracorporeal membrane oxygenation is challenging in clinical practice but represents a crucial aspect of the upgrading of therapeutic options. The aim of this study was to analyze the role of C-reactive protein and procalcitonin in the diagnosis of infection in patients requiring extracorporeal membrane oxygenation and to assess the difference between venovenous and venoarterial extracorporeal membrane oxygenation settings. Methods A case-control study was performed on 27 patients. Serum values of procalcitonin and C-reactive protein were analyzed according to the presence of infection. Results Forty-eight percent of patients had infection. Gram-negative bacteria were the predominant pathogens, and Candida albicans was the most frequent isolated microorganism. Procalcitonin had an area under the curve of 0.681 ( P  = .0062) for the diagnosis of infection in the venoarterial extracorporeal membrane oxygenation group but failed to discriminate infection in the venovenous extracorporeal membrane oxygenation group ( P  = .14). The area under the curve of C-reactive protein was 0.707 ( P  < .001) in all patients receiving extracorporeal membrane oxygenation. In patients receiving venoarterial extracorporeal membrane oxygenation, procalcitonin had good accuracy with 1.89 ng/mL as the cutoff (sensitivity = 87.8%, specificity = 50%) and C-reactive protein with 97.70 mg/L as the cutoff (sensitivity = 85.3%, specificity = 41.6%). The procalcitonin and C-reactive protein combined assay had a sensitivity of 87.2% and specificity of 25.9%. Four variables were identified as statistically significant predictors of infection: procalcitonin and C-reactive protein combined assay (odds ratio, 1.184; P  < .001), age (odds ratio, 0.980; P  < .001), presence of infection before extracorporeal membrane oxygenation implantation (odds ratio, 1.782; P  < .001), and duration of extracorporeal membrane oxygenation support (odds ratio, 1.056; P  < .001). Conclusions Traditional and emerging inflammatory biomarkers, especially if compounded in the procalcitonin and C-reactive protein combined assay, can aid in the diagnosis of infection in patients undergoing venoarterial extracorporeal membrane oxygenation.