Biomarkers for differentiation of coronavirus disease 2019 or extracorporeal membrane oxygenation related inflammation and bacterial/fungal infections in critically ill patients: A prospective observational study

Matthias Weiss-Tessbach; Franz Ratzinger; Markus Obermueller; Heinz Burgmann; Thomas Staudinger; Oliver Robak; Monika Schmid; Bernhard Roessler; Bernd Jilma; Manuel Kussmann; Ludwig Traby

doi:10.3389/fmed.2022.917606

Biomarkers for differentiation of coronavirus disease 2019 or extracorporeal membrane oxygenation related inflammation and bacterial/fungal infections in critically ill patients: A prospective observational study

Front Med (Lausanne). 2022 Oct 6:9:917606. doi: 10.3389/fmed.2022.917606. eCollection 2022.

Authors

Affiliations

¹ Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
² Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
³ Ihr Labor, Medical Diagnostics Laboratories, Vienna, Austria.
⁴ Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria.
⁵ Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
⁶ Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical Simulation and Emergency Management Research Group, Medical University of Vienna, Vienna, Austria.

Abstract

Secondary infections in coronavirus disease 2019 (COVID-19) patients are difficult to distinguish from inflammation associated with COVID-19 and/or extracorporeal membrane oxygenation (ECMO). Therefore, highly specific and sensitive biomarkers are needed to identify patients in whom antimicrobial therapy can be safely withheld. In this prospective monocentric study, 66 COVID-19 patients admitted to the intensive care unit (ICU) for ECMO evaluation were included. A total of 46 (70%) patients with secondary infections were identified by using broad microbiological and virological panels and standardized diagnostic criteria. Various laboratory parameters including C-reactive protein (CRP), interleukin (IL)-6, procalcitonin (PCT), and IL-10 were determined at time of study inclusion. The best test performance for differentiating bacterial/fungal secondary infections and COVID-19 and/or ECMO associated inflammation was achieved by IL-10 (ROC-AUC 0.84) and a multivariant step-wise regression model including CRP, IL-6, PCT, and IL-10 (ROC-AUC 0.93). Data obtained in the present study highlights the use of IL-10 to differentiate secondary bacterial/fungal infections from COVID-19 and/or ECMO associated inflammation in severely ill COVID-19 patients.

Keywords: co-infection; diagnosis differential; extracorporeal membrane oxygenation (ECMO); intensive care unit; interleukin-10; specificity and sensitivity.