Alejandro H Rodríguez1, Francesc X Avilés-Jurado2, Emili Díaz3, Philipp Schuetz4, Sandra I Trefler5, Jordi Solé-Violán6, Lourdes Cordero7, Loreto Vidaur8, Ángel Estella9, Juan C Pozo Laderas10, Lorenzo Socias11, Juan C Vergara12, Rafael Zaragoza13, Juan Bonastre14, José E Guerrero15, Borja Suberviola16, Catia Cilloniz17, Marcos I Restrepo18, Ignacio Martín-Loeches19. 1. Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV/CIBERes, Tarragona, Spain. Electronic address: ahr1161@yahoo.es. 2. Otorhinolaryngology Head-Neck Surgery Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV, Tarragona, Catalonia, Spain. Electronic address: fxavilesj@gmail.com. 3. Critical Care Department, ParcTaulí Hospital/CIBERes, Sabadell, Spain. Electronic address: emilio.diaz.santos@gmail.com. 4. Internal Medicine Department, Kantonsspital Aarau, Switzerland. Electronic address: schuetzph@gmail.com. 5. Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV/CIBERes, Tarragona, Spain. Electronic address: sitrefler@yahoo.es. 6. Critical Care Department, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain. Electronic address: jsolvio@gobiernodecanarias.org. 7. Critical Care Department, CHUAC, A Coruña, Spain. Electronic address: lcorlor@gmail.com. 8. Critical Care Department, Hospital de Donostia, San Sebastian, Spain. Electronic address: loreto.vidaurtello@osakidetza.net. 9. Critical Care Department, Hospital SAS, Jerez de la Frontera, Spain. Electronic address: litoestella@hotmail.com. 10. Critical Care Department, Hospital Reina Sofía, Córdoba, Spain. Electronic address: juanc.pozo.sspa@juntadeandalucia.es. 11. Critical Care Department, Hospital Son Llatzer, Palma de Mallorca, Spain. Electronic address: lsocias3@gmail.com. 12. Critical Care Department, Hospital de Cruces, Vizcaya, Spain. Electronic address: juancarlos.vergaraserrano@osakidetza.net. 13. Critical Care Department, Hospital Dr. Peset, Valencia, Spain. Electronic address: zaragozar@ono.com. 14. Critical Care Department, Hospital La Fe, Valencia, Spain. Electronic address: bonastre_jua@gva.es. 15. Critical Care Department, Hospital Gregorio Marañón, Madrid, Spain. Electronic address: jeguerrerosanz@gmail.com. 16. Critical Care Department, Hospital Universitario de Santander, Spain. Electronic address: borja.suberviola@gmail.com. 17. Critical Care Department, Hospital Clinic / CIBERES, Barcelona, Spain. Electronic address: catiacilloniz@yahoo.com. 18. Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center at San Antonio San Antonio, TX, USA. Electronic address: restrepom@uthscsa.edu. 19. Multidisciplinary Intensive Care Research Organization (MICRO), Department of Anaesthesia and Critical Care, St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland. Electronic address: drmartinloeches@gmail.com.
Abstract
OBJECTIVES: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. METHODS: A secondary analysis from a prospective, multicentre, observational study (2009-2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the binominal distributions of the true (+) and true (-) results. RESULTS: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT <0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT <0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. CONCLUSION: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.
OBJECTIVES: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. METHODS: A secondary analysis from a prospective, multicentre, observational study (2009-2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the binominal distributions of the true (+) and true (-) results. RESULTS: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT <0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT <0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. CONCLUSION: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.
Authors: Michael Klompas; Peter B Imrey; Pei-Chun Yu; Chanu Rhee; Abhishek Deshpande; Sarah Haessler; Marya D Zilberberg; Michael B Rothberg Journal: Infect Control Hosp Epidemiol Date: 2020-12-01 Impact factor: 6.520