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Diagnostic Performance of Fludeoxyglucose (FDG) Positron Emission Tomography (PET) in Critically Ill Patients with Sepsis of Unknown Origin: A Systematic Review and Meta-Analysis
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A6813 - Diagnostic Performance of Fludeoxyglucose (FDG) Positron Emission Tomography (PET) in Critically Ill Patients with Sepsis of Unknown Origin: A Systematic Review and Meta-Analysis
Author Block: C. Huang1, J. Huang2, S. Ruan3, K. Chien1; 1Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, 2Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan, 3National Taiwan University Hospital, Taipei, Taiwan.
RATIONALE Sepsis is now defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Early identification of true infectious focus and appropriate management in the initial hours after sepsis develops improves outcomes. Several studies have assessed the diagnostic usefulness of nuclear imaging tests, including gallium scintigraphy and fludeoxyglucose (FDG) positron emission tomography (PET) for localizing a source of infection. However, few studies targeted on critically ill patients with sepsis of unknown origin. Therefore, this review attempted to address the evidence on the diagnostic performance and clinical utility of FDG PET and gallium scintigraphy for critically ill patients with sepsis of unknown origin. METHODS We searched PubMed and Embase through October 15, 2017, for studies evaluating gallium scintigraphy and FDG PET for finding infection focus in critically ill patients. Two reviewers extracted data. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Pooled measures for diagnostic performance, including sensitivity, specificity, area under the curve (AUC) with 95% confidence intervals (CIs) and publication bias were calculated by STATA14. We also performed diagnostic odds ratio (DOR) and sensitivity analysis using R (with package “MADA”). RESULTS We screened 27 abstracts and evaluated 10 full-text articles. A total of 4 publications, (87 patients with 89 independent tests) met our eligibility criteria. Four studies all evaluated FDG PET and there was no study related to gallium scintigraphy. The summary sensitivity and specificity were 0.94 (95% CI, 0.79-0.99) and 0.66 (95% CI, 0.45-0.83), respectively. The summary receiver operating characteristic curve revealed AUC=0.83. The Deek’s funnel plot asymmetry test showed significant publication bias with p value 0.06(8). Sensitivity analysis for the 4 studies showed similar natural logarithm DOR ranged from 2.19 to 3.33. CONCLUSIONS Summary diagnostic performance showed that FDG PET was a very sensitive tool with acceptable specificity in detecting sepsis origin in critically ill patients. However, risk for transportation remained a major concern in these patients. Further prospective study should be done to evaluate the use of FDG PET in critically ill patients with sepsis of unknown origin.
Author Block: C. Huang1, J. Huang2, S. Ruan3, K. Chien1; 1Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, 2Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan, 3National Taiwan University Hospital, Taipei, Taiwan.
RATIONALE Sepsis is now defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Early identification of true infectious focus and appropriate management in the initial hours after sepsis develops improves outcomes. Several studies have assessed the diagnostic usefulness of nuclear imaging tests, including gallium scintigraphy and fludeoxyglucose (FDG) positron emission tomography (PET) for localizing a source of infection. However, few studies targeted on critically ill patients with sepsis of unknown origin. Therefore, this review attempted to address the evidence on the diagnostic performance and clinical utility of FDG PET and gallium scintigraphy for critically ill patients with sepsis of unknown origin. METHODS We searched PubMed and Embase through October 15, 2017, for studies evaluating gallium scintigraphy and FDG PET for finding infection focus in critically ill patients. Two reviewers extracted data. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Pooled measures for diagnostic performance, including sensitivity, specificity, area under the curve (AUC) with 95% confidence intervals (CIs) and publication bias were calculated by STATA14. We also performed diagnostic odds ratio (DOR) and sensitivity analysis using R (with package “MADA”). RESULTS We screened 27 abstracts and evaluated 10 full-text articles. A total of 4 publications, (87 patients with 89 independent tests) met our eligibility criteria. Four studies all evaluated FDG PET and there was no study related to gallium scintigraphy. The summary sensitivity and specificity were 0.94 (95% CI, 0.79-0.99) and 0.66 (95% CI, 0.45-0.83), respectively. The summary receiver operating characteristic curve revealed AUC=0.83. The Deek’s funnel plot asymmetry test showed significant publication bias with p value 0.06(8). Sensitivity analysis for the 4 studies showed similar natural logarithm DOR ranged from 2.19 to 3.33. CONCLUSIONS Summary diagnostic performance showed that FDG PET was a very sensitive tool with acceptable specificity in detecting sepsis origin in critically ill patients. However, risk for transportation remained a major concern in these patients. Further prospective study should be done to evaluate the use of FDG PET in critically ill patients with sepsis of unknown origin.
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