Novel Biomarker for Early Sepsis Detection in Patients Supported by ECMO

Abstract

Background: Sepsis is a significant complication in ECMO patients. Traditional biomarkers have low diagnostic accuracy for diagnosing infections on ECMO. MDW is a novel biomarker reflecting changes in the volume of monocytes in response to infectious organisms. Objective: To analyze the relationship between MDW, ECMO therapy and infection. Methods: Retrospective study of adult patients on ECMO since 2019. Sepsis biomarkers were measured before, during and after ECMO. Results: 134 patients. VV ECMO 67.9% (CI 95%: 59.3–75.7). Nosocomial respiratory infection was the most prevalent (72.4%: CI 95%: 64–80). MDW values differed significantly two days before ECMO implementation (p = 0.000). MDW was higher in VA ECMO (28.5; SD 1.1) than VV ECMO (25.2; SD 0.9), p = 0.02. MDW increased on the day of respiratory (27; SD 9.4) and bloodstream (26.7; SD 9.5) infections (p = 0.02). MDW had good performance for predicting bloodstream infections in VA ECMO (AUC 0.8; 95% CI: 0.52–0.96), being 38.3 the cut-off point for predicting bacteremia. Conclusions: MDW was higher in ECMO patients, likely due to inflammation from extracorporeal therapy. This biomarker shows promise for early infection detection and sepsis monitoring.