Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Milan, Italy.
J Thorac Cardiovasc Surg. 2012 Jun;143(6):1411-6. doi: 10.1016/j.jtcvs.2012.01.005. Epub 2012 Feb 2.
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.
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.
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).
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.
在接受体外膜肺氧合（ECMO）的患者中，感染的诊断在临床实践中具有挑战性，但这是升级治疗选择的关键方面。本研究的目的是分析 C 反应蛋白和降钙素原在诊断需要 ECMO 的患者感染中的作用，并评估静脉-静脉和静脉-动脉 ECMO 设置之间的差异。
对 27 例患者进行病例对照研究。根据感染的存在分析降钙素原和 C 反应蛋白的血清值。
48%的患者发生感染。革兰氏阴性菌是主要病原体，最常分离到的微生物是白色念珠菌。降钙素原在静脉-动脉 ECMO 组中对感染的诊断的曲线下面积为 0.681（P =.0062），但未能区分静脉-静脉 ECMO 组中的感染（P =.14）。所有接受 ECMO 的患者的 C 反应蛋白曲线下面积为 0.707（P <.001）。在接受静脉-动脉 ECMO 的患者中，降钙素原以 1.89ng/mL 为截点具有良好的准确性（灵敏度=87.8%，特异性=50%），C 反应蛋白以 97.70mg/L 为截点具有良好的准确性（灵敏度=85.3%，特异性=41.6%）。降钙素原和 C 反应蛋白联合检测的敏感性为 87.2%，特异性为 25.9%。有 4 个变量被确定为感染的统计学显著预测因子：降钙素原和 C 反应蛋白联合检测（比值比，1.184；P <.001）、年龄（比值比，0.980；P <.001）、ECMO 植入前存在感染（比值比，1.782；P <.001）和 ECMO 支持时间（比值比，1.056；P <.001）。
传统和新兴的炎症生物标志物，尤其是降钙素原和 C 反应蛋白联合检测，如果联合应用，可辅助诊断接受静脉-动脉 ECMO 的患者的感染。
