医学
病因学
急性呼吸衰竭
试验前后概率
队列
呼吸衰竭
插管
重症监护医学
人口
呼吸系统
生物标志物
队列研究
呼吸道感染
内科学
急诊医学
机械通风
外科
化学
环境卫生
生物化学
作者
Maria E. Koster‐Brouwer,Diana M. Verboom,Brendon P. Scicluna,Kirsten van de Groep,Jos F. Frencken,Davy Janssen,Rob Schuurman,Marcus J. Schultz,Tom van der Poll,Marc J. M. Bonten,Olaf L. Cremer
标识
DOI:10.1097/ccm.0000000000002735
摘要
Discrimination between infectious and noninfectious causes of acute respiratory failure is difficult in patients admitted to the ICU after a period of hospitalization. Using a novel biomarker test (SeptiCyte LAB), we aimed to distinguish between infection and inflammation in this population.Nested cohort study.Two tertiary mixed ICUs in the Netherlands.Hospitalized patients with acute respiratory failure requiring mechanical ventilation upon ICU admission from 2011 to 2013. Patients having an established infection diagnosis or an evidently noninfectious reason for intubation were excluded.None.Blood samples were collected upon ICU admission. Test results were categorized into four probability bands (higher bands indicating higher infection probability) and compared with the infection plausibility as rated by post hoc assessment using strict definitions. Of 467 included patients, 373 (80%) were treated for a suspected infection at admission. Infection plausibility was classified as ruled out, undetermined, or confirmed in 135 (29%), 135 (29%), and 197 (42%) patients, respectively. Test results correlated with infection plausibility (Spearman's rho 0.332; p < 0.001). After exclusion of undetermined cases, positive predictive values were 29%, 54%, and 76% for probability bands 2, 3, and 4, respectively, whereas the negative predictive value for band 1 was 76%. Diagnostic discrimination of SeptiCyte LAB and C-reactive protein was similar (p = 0.919).Among hospitalized patients admitted to the ICU with clinical uncertainty regarding the etiology of acute respiratory failure, the diagnostic value of SeptiCyte LAB was limited.
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