Chonnam Med J.  2018 Jan;54(1):48-54. 10.4068/cmj.2018.54.1.48.

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

• Kim DW
• Cho HJ
• Kim GS
• Song SY
• Na KJ
• Oh SG
• Oh BS
• Jeong IS

• KMID: 2458585
• DOI: http://doi.org/10.4068/cmj.2018.54.1.48

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.

Keyword

Extracorporeal membrane oxygenation; Calcitonin; Cross infection; Shock; Cardiogenic

MeSH Terms

Adult*
Bacterial Infections
Calcitonin
Critical Illness
Cross Infection
Extracorporeal Membrane Oxygenation*
Female
Humans
Mortality
Shock
Shock, Cardiogenic*
Weaning
Calcitonin

Figure

• 

  FIG. 1 Algorithm of patient selection in our study. ECMO: extracorporeal membrane oxygenation, ECPR: extracorporeal cardiopulmonary resuscitation, VA: veno-arterial, VAV: veno-arterial venous, VV: veno-venous, PCT: procalcitonin.

• 

  FIG. 2 Trends of Procalcitonin levels during ECMO support for 28dyas, presented as mean value±standard deviation. Peak value was reached within 48 hours after initiation of ECMO support (mean 25.6±9.4 ng/mL), and decreased to ≤5 ng/mL within 1 week. Mean value of PCT levels after first week varied in diverse patterns, but did not show the high levels shown for the first week. ECMO: extracorporeal membrane oxygenation, PCT: procalcitonin.

• 

  FIG. 3 Comparison between mean PCT levels within 7 days in survivors and non-survivors. Serial progression of mean PCT level was observed during the first week of ECMO support; the mean level was significantly higher over time in the survivor group (p=0.03). ECMO: extracorporeal membrane oxygenation, PCT: procalcitonin.

• 

  FIG. 4 Kaplan-Meier survival analysis: Peak PCT level ≥10 ng/mL in survivors and non-survivors. PCT level ≥10 ng/mL within the first week of ECMO support was significantly associated with survival probability (p=0.01). ECMO: extracorporeal membrane oxygenation, PCT: procalcitonin.

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