Predictive Value of Procalcitonin for Infection and Survival in Adult Cardiogenic Shock Patients Treated with Extracorporeal Membrane Oxygenation

Abstract

Procalcitonin (PCT) is a predictive marker for the occurrence of bacterial infection and the decision to terminate antibiotic treatment in critically ill patients. An unusual increase in PCT, regardless of infection, has been observed during extracorporeal membrane oxygenation (ECMO) support. We evaluated trends and the predictive value of PCT levels in adult cardiogenic shock during treatment with ECMO. We reviewed the clinical records of 38 adult cardiogenic shock patients undergoing veno-arterial ECMO support between January 2014 and December 2016. The exclusion criteria were age <18 years, pre-ECMO infection, and less than 48 hours of support. The mean patient age was 56.7±14.7 years and 12 (31.6%) patients were female. The mean duration of ECMO support was 9.0±7.6 days. The rates of successful ECMO weaning and survival to discharge were 55.3% (n=21) and 52.6% (n=20), respectively. There were 17 nosocomial infections in 16 (42.1%) patients. Peak PCT levels (mean 25.6±9.4 ng/mL) were reached within 48 hours after initiation of ECMO support and decreased to ≤5 ng/mL within one week. The change in PCT levels was not useful in predicting the occurrence of new nosocomial infections during the ECMO run. However, a PCT level >10 ng/mL during the first week of ECMO support was significantly associated with mortality (p<0.01). The change in PCT level was not useful in predicting new infection during ECMO support. However, higher PCT levels within the first week of the ECMO run are associated with significantly higher mortality.

Bloodstream infections during post-cardiotomy extracorporeal membrane oxygenation: Incidence, risk factors, and outcomes

“…Previous studies already outlined the limited predictive value of conventional markers of BSI in the setting of VA-ECMO. 22 However, this concept is not universally shared, and other authors found an acceptable level of prediction of infections in ECMO patients for both PCT and CRP 23 in a case-control study on 27 patients. However, this study included every kind of infection and not BSI only, and 70% of the reported infections were pneumonia.…”

(Early and late complications of extracorporeal membrane oxygenation)

“…Z výsledků analyzovaných studií je patrné, že nejčastější komplikací bylo krvácení (n -1 435/33,65 %), dále komplikace renální (n -948/ 22,23 %), neurologické (n -915/ 21,45 %), infekční (n -504/ 11,82 %), vaskulární (n -269/ 6,31 %) a mechanické (n -194/ 4,55 %) (tabulka 1). [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Z celkového počtu identifi kovaných krvácivých komplikací (n -1435/33,65 %) uváděli autoři četnost torakotomií z důvodu hrudního krvácení nebo srdeční tamponády (n -642/ 44,74 %). Torakotomii je nutné považovat za chirurgický (intervenční) výkon provedený v důsledku krvácivých komplikací.…”

“…24 S tím souvisí i vyšší náchylnost k nozokomiálním nákazám, jejichž přítomnost potvrzuje ve studii také Kim a spol. 18 V literatuře se udává, že 13-26 % hlášených nozokomiálních infekcí u dospělých pacientů, kteří jsou na mimotělní podpoře, je spojeno s infekcí ještě před zahájením terapie. Mezi nejčastější nozokomiální infekce patří infekce dýchacích cest, močové infekce a infekce v místě chirurgických zákroků.…”

“…Významným rizikovým faktorem je například věk nad 65 let. [14][15][16][17][18][19] Autoři Yeh a spol. 27 však uvádějí, že samotný věk by neměl vylučovat pacienty, aby byli kandidáty na podporu ECMO.…”

Diagnostic yield of routine daily blood culture in patients on veno-arterial extracorporeal membrane oxygenation

“…Body temperature cannot be interpreted because of blood exposure to heat exchanger. White blood cell count and common biomarkers lack of specificity in the setting of cardiogenic shock both on medical treatment and on V-A ECMO [ 4 , 5 ]. To overcome diagnosis, routine blood cultures (BCs) are proposed [ 6 , 7 ].…”