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

Irene Doo; Lukas P Staub; Adrian Mattke; Emma Haisz; Anna Lene Seidler; Nelson Alphonso; Luregn J Schlapbach

doi:10.3389/fped.2021.824552

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

Front Pediatr. 2022 Jan 26:9:824552. doi: 10.3389/fped.2021.824552. eCollection 2021.

Authors

Irene Doo^{1

2}, Lukas P Staub³, Adrian Mattke^{1

2}, Emma Haisz^{1

2}, Anna Lene Seidler³, Nelson Alphonso⁴, Luregn J Schlapbach^{1

2

5}

Affiliations

¹ Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.
² Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
³ National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
⁴ Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, QLD, Australia.
⁵ Department of Intensive Care Medicine and Neonatology, and Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: C-reactive protein; diagnostic accuracy; extracorporeal life support; extracorporeal membrane oxygenation; infection; pediatric; procalcitonin; white cell count.