Table_1_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.XLSX

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.

新型冠状病毒肺炎（COVID-19）患者的继发感染，难以与新冠病毒感染本身及/或体外膜肺氧合（extracorporeal membrane oxygenation, ECMO）相关炎症相鉴别。因此，亟需兼具高特异性与高敏感性的生物标志物，以识别出可安全停用抗菌药物治疗的患者。本项前瞻性单中心研究共纳入66例因需评估ECMO治疗而入住重症监护病房（intensive care unit, ICU）的新冠患者。通过广谱微生物与病毒学检测组套及标准化诊断标准，共确诊46例（占比70%）继发感染患者。入组时检测了多项实验室指标，包括C反应蛋白（C-reactive protein, CRP）、白细胞介素-6（interleukin-6, IL-6）、降钙素原（procalcitonin, PCT）及白细胞介素-10（interleukin-10, IL-10）。在鉴别细菌/真菌继发感染与新冠病毒感染及/或ECMO相关炎症的任务中，白细胞介素-10（IL-10）的检测效能最优（受试者工作特征曲线下面积[ROC-AUC]为0.84），而包含CRP、IL-6、PCT及IL-10的多变量逐步回归模型效能更佳（ROC-AUC为0.93）。本研究所得数据证实，白细胞介素-10（IL-10）可用于区分重症新冠患者的继发细菌/真菌感染与新冠病毒感染及/或ECMO相关炎症。