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

Abstract

BackgroundInfections 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.MethodsRetrospective 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.ResultsSixty-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.ConclusionThe 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.

ECMO in Cardiogenic Shock: Time Course of Blood Biomarkers and Associated Mortality

“…Clearly, it is challenging to distinguish the extent of inflammation solely due to extracorporeal support or due to an underlying disease or even therapeutical and surgical interventions in patients on support [ 26 , 31 ]. Recently, an increased PCT has been shown to be non-discriminative between confirmed and suspected infection during ECMO in nearly 60 neonates and children [ 32 ]. Moreover, an increased PCT failed to estimate prognosis early in nearly 350 adult patients with va-ECMO support.…”

A Comprehensive Review of Extra Corporeal Membrane Oxygenation: The Lifeline in Critical Moments

“…Rigorous screening for infections, including blood cultures and other relevant tests, allows for the early detection and targeted treatment of infectious processes. This proactive approach is essential in preventing complications and optimizing the overall success of ECMO therapy [29].…”

Nosocomial infections during extracorporeal membrane oxygenation

“…Furthermore, the exposure of blood to the extracorporeal circuit causes the activation of cellular and humoral systems that cause an inflammatory response cascade that may mimic analytical signs of infection [2]. The performance of common diagnostic test, such as C-reactive protein and procalcitonin, to discriminate infection from inflammation is limited, with conflicting results in various series [30 ▪ ,31,32]. Moreover, the underlying disease may hinder the interpretation of basic image tests such as chest X-rays.…”