PDF(Pubmed)
Abstract：
UNASSIGNED: Identifying secondary infections in patients receiving extracorporeal membrane oxygenation (ECMO) presents challenges due to the ECMO circuit\'s influence on traditional signs of infection.
UNASSIGNED: This study evaluates procalcitonin as a diagnostic marker for secondary infections in patients receiving ECMO with influenza or COVID-19 infection.
UNASSIGNED: Single-center retrospective cohort study.
UNASSIGNED: All adult patients receiving veno-venous ECMO with underlying influenza or COVID-19 from November 2017 to October 2021 were included. Patient demographics, time receiving ECMO, culture data, and procalcitonin levels were examined. The first procalcitonin within 3 days of infection was compared to negative workups that were collected at least 10 days from the last positive culture. Furthermore, we compared procalcitonin levels by the type of pathogen and site of infection.
UNASSIGNED: In this study, 84 patients with influenza or COVID-19 who received ECMO were included. A total of 276 procalcitonin labs were ordered in this cohort, with 33/92 (36%) of the secondary infections having an associated procalcitonin value. When comparing procalcitonin levels, there was no significant difference between the infection and negative workup groups [1 ng/mL (interquartile ranges, IQR: 0.4-1.2) versus 1.3 (0.5-4.3), p = 0.19]. Using 0.5 ng/mL as the cut-off, the sensitivity of procalcitonin was 67% and the specificity was 30%. In our cohort, the positive predictive value of procalcitonin was 14.5% and the negative predictive value was 84%. There was no difference in procalcitonin by type of organism or site of infection. Procalcitonin levels did not routinely decline even after an infection was identified.
UNASSIGNED: While procalcitonin is a proposed potential diagnostic marker for secondary infections in patients receiving ECMO, this single-center study demonstrated low sensitivity and specificity of procalcitonin in identifying secondary infections. Furthermore, there was no association of procalcitonin levels with etiology of infection when one was present. Procalcitonin should be used cautiously in identifying infections in veno-venous ECMO.
The utility of procalcitonin for identifying secondary infections in patients with influenza or COVID-19 receiving extracorporeal membrane oxygenation Aim: To determine if procalcitonin performs well as a diagnostic marker in identifying additional infections in adult patients receiving ECMO with influenza or COVID-19.
BACKGROUND: It is very difficult to determine whether patients receiving ECMO have infections as both vital signs and laboratory markers have not shown good utility. Procalcitonin is a laboratory test sometimes used to identify infections, but its test performance is not known in this population.
METHODS: We performed a study of adult patient patients receiving ECMO to determine if there were differences in procalcitonin levels when patients had infections as compared to when they did not have infections. We also looked to see if procalcitonin levels routinely dropped after an infection was diagnosed.
RESULTS: Procalcitonin values were no different when patients had an infection as compared to when they did not have an infection. Using standard laboratory cut-offs, the procalcitonin sensitivity was 67%, and specificity was 30%. Procalcitonin levels did not routinely decline even after an infection was identified.
CONCLUSIONS: Procalcitonin poorly differentiated patients with infections from those without infections and should be used with caution in patients receiving ECMO.
UNASSIGNED: This study evaluates procalcitonin as a diagnostic marker for secondary infections in patients receiving ECMO with influenza or COVID-19 infection.
UNASSIGNED: Single-center retrospective cohort study.
UNASSIGNED: All adult patients receiving veno-venous ECMO with underlying influenza or COVID-19 from November 2017 to October 2021 were included. Patient demographics, time receiving ECMO, culture data, and procalcitonin levels were examined. The first procalcitonin within 3 days of infection was compared to negative workups that were collected at least 10 days from the last positive culture. Furthermore, we compared procalcitonin levels by the type of pathogen and site of infection.
UNASSIGNED: In this study, 84 patients with influenza or COVID-19 who received ECMO were included. A total of 276 procalcitonin labs were ordered in this cohort, with 33/92 (36%) of the secondary infections having an associated procalcitonin value. When comparing procalcitonin levels, there was no significant difference between the infection and negative workup groups [1 ng/mL (interquartile ranges, IQR: 0.4-1.2) versus 1.3 (0.5-4.3), p = 0.19]. Using 0.5 ng/mL as the cut-off, the sensitivity of procalcitonin was 67% and the specificity was 30%. In our cohort, the positive predictive value of procalcitonin was 14.5% and the negative predictive value was 84%. There was no difference in procalcitonin by type of organism or site of infection. Procalcitonin levels did not routinely decline even after an infection was identified.
UNASSIGNED: While procalcitonin is a proposed potential diagnostic marker for secondary infections in patients receiving ECMO, this single-center study demonstrated low sensitivity and specificity of procalcitonin in identifying secondary infections. Furthermore, there was no association of procalcitonin levels with etiology of infection when one was present. Procalcitonin should be used cautiously in identifying infections in veno-venous ECMO.
The utility of procalcitonin for identifying secondary infections in patients with influenza or COVID-19 receiving extracorporeal membrane oxygenation Aim: To determine if procalcitonin performs well as a diagnostic marker in identifying additional infections in adult patients receiving ECMO with influenza or COVID-19.
BACKGROUND: It is very difficult to determine whether patients receiving ECMO have infections as both vital signs and laboratory markers have not shown good utility. Procalcitonin is a laboratory test sometimes used to identify infections, but its test performance is not known in this population.
METHODS: We performed a study of adult patient patients receiving ECMO to determine if there were differences in procalcitonin levels when patients had infections as compared to when they did not have infections. We also looked to see if procalcitonin levels routinely dropped after an infection was diagnosed.
RESULTS: Procalcitonin values were no different when patients had an infection as compared to when they did not have an infection. Using standard laboratory cut-offs, the procalcitonin sensitivity was 67%, and specificity was 30%. Procalcitonin levels did not routinely decline even after an infection was identified.
CONCLUSIONS: Procalcitonin poorly differentiated patients with infections from those without infections and should be used with caution in patients receiving ECMO.
摘要：
■由于ECMO回路对传统感染迹象的影响，在接受体外膜氧合（ECMO）的患者中识别继发感染提出了挑战。
■这项研究评估了降钙素原作为接受ECMO合并流感或COVID-19感染的患者继发感染的诊断标志物。
■单中心回顾性队列研究。
■从2017年11月至2021年10月接受静脉-静脉ECMO伴潜在流感或COVID-19的所有成年患者均包括在内。患者人口统计学，接收ECMO的时间，文化数据，并检查降钙素原水平。将感染3天内的第一次降钙素原与从最后一次阳性培养物至少10天收集的阴性检查进行比较。此外，我们根据病原体类型和感染部位比较了降钙素原水平.
■在这项研究中，包括84例接受ECMO的流感或COVID-19患者。该队列共订购了276个降钙素原实验室，33/92（36％）的继发感染具有相关的降钙素原值。当比较降钙素原水平时，感染组和阴性检查组[1ng/mL(四分位距，IQR：0.4-1.2）对1.3（0.5-4.3），p=0.19]。使用0.5ng/mL作为截止值，降钙素原的敏感性为67%,特异性为30%.在我们的队列中，降钙素原的阳性预测值为14.5%,阴性预测值为84%.不同生物类型或感染部位的降钙素原没有差异。即使在确定感染后，降钙素原水平也不会常规下降。
虽然降钙素原是接受ECMO治疗的患者继发感染的潜在诊断标志物，这项单中心研究表明,降钙素原在鉴别继发感染方面的敏感性和特异性较低.此外，降钙素原水平与感染的病因无相关性.在确定静脉-静脉ECMO感染时应谨慎使用降钙素原。
降钙素原在识别接受体外膜氧合的流感或COVID-19患者继发感染中的应用目的：确定降钙素原在识别接受ECMO流感或COVID-19的成年患者的其他感染中是否作为诊断标志物。
背景：由于生命体征和实验室标志物均未显示出良好的效用，因此很难确定接受ECMO的患者是否感染。降钙素原是一种实验室检查，有时用于识别感染，但它的测试性能在这个人群中是未知的。
方法：我们对接受ECMO的成年患者进行了一项研究，以确定患者感染时与未感染时相比，降钙素原水平是否存在差异。我们还观察了在诊断出感染后降钙素原水平是否经常下降。
结果：患者感染时与未感染时相比，降钙素原值没有差异。使用标准实验室截止值,降钙素原敏感性为67%,特异性为30%。即使在确定感染后，降钙素原水平也不会常规下降。
结论：降钙素原分化差的感染患者与非感染患者相比，接受ECMO的患者应谨慎使用。
■这项研究评估了降钙素原作为接受ECMO合并流感或COVID-19感染的患者继发感染的诊断标志物。
■单中心回顾性队列研究。
■从2017年11月至2021年10月接受静脉-静脉ECMO伴潜在流感或COVID-19的所有成年患者均包括在内。患者人口统计学，接收ECMO的时间，文化数据，并检查降钙素原水平。将感染3天内的第一次降钙素原与从最后一次阳性培养物至少10天收集的阴性检查进行比较。此外，我们根据病原体类型和感染部位比较了降钙素原水平.
■在这项研究中，包括84例接受ECMO的流感或COVID-19患者。该队列共订购了276个降钙素原实验室，33/92（36％）的继发感染具有相关的降钙素原值。当比较降钙素原水平时，感染组和阴性检查组[1ng/mL(四分位距，IQR：0.4-1.2）对1.3（0.5-4.3），p=0.19]。使用0.5ng/mL作为截止值，降钙素原的敏感性为67%,特异性为30%.在我们的队列中，降钙素原的阳性预测值为14.5%,阴性预测值为84%.不同生物类型或感染部位的降钙素原没有差异。即使在确定感染后，降钙素原水平也不会常规下降。
虽然降钙素原是接受ECMO治疗的患者继发感染的潜在诊断标志物，这项单中心研究表明,降钙素原在鉴别继发感染方面的敏感性和特异性较低.此外，降钙素原水平与感染的病因无相关性.在确定静脉-静脉ECMO感染时应谨慎使用降钙素原。
降钙素原在识别接受体外膜氧合的流感或COVID-19患者继发感染中的应用目的：确定降钙素原在识别接受ECMO流感或COVID-19的成年患者的其他感染中是否作为诊断标志物。
背景：由于生命体征和实验室标志物均未显示出良好的效用，因此很难确定接受ECMO的患者是否感染。降钙素原是一种实验室检查，有时用于识别感染，但它的测试性能在这个人群中是未知的。
方法：我们对接受ECMO的成年患者进行了一项研究，以确定患者感染时与未感染时相比，降钙素原水平是否存在差异。我们还观察了在诊断出感染后降钙素原水平是否经常下降。
结果：患者感染时与未感染时相比，降钙素原值没有差异。使用标准实验室截止值,降钙素原敏感性为67%,特异性为30%。即使在确定感染后，降钙素原水平也不会常规下降。
结论：降钙素原分化差的感染患者与非感染患者相比，接受ECMO的患者应谨慎使用。
