Doo Irene, Staub Lukas P, Mattke Adrian, Haisz Emma, Seidler Anna Lene, Alphonso Nelson, Schlapbach Luregn J
Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.
Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
Front Pediatr. 2022 Jan 26;9:824552. doi: 10.3389/fped.2021.824552. eCollection 2021.
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.
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.
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.
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.
感染是接受体外膜肺氧合（ECMO）治疗的患者中最常见的并发症之一，且与较差的预后相关。接受ECMO治疗的患者感染的临床症状不具有特异性。我们评估了降钙素原（PCT）、C反应蛋白（CRP）和白细胞计数（WCC）对诊断ECMO患者感染的准确性。
回顾性单中心观察性研究，纳入2015年和2016年接受ECMO治疗的18岁以下新生儿和儿童。使用操作特征（ROC）曲线，评估每日PCT、CRP和WCC数据与ECMO上微生物学确诊及临床疑似感染的关系。
对58例患者的65次ECMO运行进行了评估。CRP诊断确诊感染的准确性最佳，ROC曲线下面积（AUC）为0.79（95%可信区间0.66 - 0.92），诊断确诊和疑似感染的AUC为0.72（0.61 - 0.84）。WCC异常的诊断准确性稍差，确诊感染的AUC为0.70（0.59 - 0.81），确诊和疑似感染的AUC为0.66（0.57 - 0.75）。PCT无鉴别诊断价值。
ECMO期间获得性感染的诊断仍然具有挑战性。需要开展更大规模的前瞻性研究，纳入新的感染标志物，以提高对ECMO患者感染的识别。
