Inflammatory markers may predict infection for children on ECLS

Abstract

Introduction: Extracorporeal life support (ECLS) has gained widespread acceptance as rescue treatment for refractory cardiovascular and respiratory failure in adults and children. Infections are common complications in patients managed on ECLS, occurring in over 10-20% of patients. Clinical signs of infection in patients on ECLS are non-specific and masked, making diagnosis of infection challenging. Objectives: This study aims to assess the diagnostic value of infection markers (C-reactive protein (CRP), Procalcitonin (PCT), White cell count (WCC)) to diagnose infection on ECLS. Methods: We performed a retrospective single centre observational study of all 65 ECMO runs in 58 patients in a tertiary Paediatric ICU between 1st January 2015 to 31st December 2016. CRP, WCC, PCT, and blood cultures were taken daily. Infection markers obtained within 24 hours of blood culture sampling were compared between patients with and without infection. Results: Out of 538 ECLS days, antibiotics were administered on 292 days (54%) for suspected (82 days) or confirmed infection (210 days). CRP and CRP combined with WCC resulted in the best performance, with areas under the curve (AUC) of 0.79 (95%-CI 0.73-0.85) and 0.78 (0.72-0.84), respectively, while PCT was not discriminatory with AUC 0.52 (0.44-0.60). For confirmed infection, CRP performed best with AUC 0.82 (0.756-0.885)) , followed by CRP+WCC AUC 0.81 (0.746-0.873) ) and PCT AUC 0.523 (0.435-0.612). Conclusion(s): While CRP and CRP combined with WCC performed best to diagnose infection for children on ECLS, the diagnostic accuracy was only moderate. Larger prospective studies are needed to test novel markers of infection.L6316188692020-05-05 <br />