Abstract
PurposeThe role of FDG PET in the evaluation of patients with sepsis of unknown origin remains unclear. We sought to assess the value of FDG PET/CT in patients with sepsis of unknown cause and to define its priority in this group of subjects.MethodsA total of 53 patients with sepsis of unknown origin underwent FDG PET/CT within two weeks of diagnosis. All of the patients were followed up for at least 3 months after discharge to determine the clinical outcomes. The impact of FDG PET/CT was assessed according to the number of cases who had their treatment modified on the basis of the imaging results. Logistic regression analysis was used to identify the independent predictors of positive FDG PET/CT findings.ResultsOf the 53 study patients, 35 (66%) had positive FDG PET/CT findings, and 13 (25%) had their treatment modified on the basis of the imaging results. Logistic regression analysis identified normal serum aspartate aminotransferase (odds ratio [OR] = 6.134; 95% confidence interval [CI] = 1.443–26.076, P = 0.014) and increased serum alkaline phosphatase levels (OR = 5.813; 95% CI = 1.386–24.376, P = 0.016) at diagnosis as independent predictors of positive FDG PET/CT findings. A scoring system using these two covariates was developed, which defined three distinct priority groups for FDG PET/CT imaging.ConclusionOur findings suggest that FDG PET/CT may be clinically useful for the detection of occult foci of infection in patients with sepsis of unknown origin.
Highlights
The identification of occult sources of infection is of paramount importance to improve the outcomes of patients with sepsis [1]
Previous studies have shown that FDG PET/CT is superior to conventional imaging modalities in several infectious and inflammatory disorders, including osteomyelitis, infected vascular grafts, metastatic infectious disease, vasculitis, sarcoidosis, inflammatory bowel disease, and fever of unknown origin [2,3]
Patients and clinical management Between October 1, 2011 and September 30, 2012, we identified a total of 53 patients who were admitted to the Chang Gung Memorial Hospital (CGMH) at Linkou because of sepsis of unknown origin and who underwent FDG PET/CT within two weeks of diagnosis
Summary
The identification of occult sources of infection is of paramount importance to improve the outcomes of patients with sepsis [1]. Several radiopharmaceuticals have been used for the detection of infectious foci, including autologous white blood cells labeled with Technetium-99m (Tc-99m) or Indium-111 (In-111), Tc-99m-labeled bisphosphonates, and Gallium-67 (Ga-67) citrate [2]. These compounds have inherent shortcomings, including being inconvenient and time-consuming (autologous white blood cells labeling), having low specificity despite a high sensitivity (Tc-99m labeled bisphosphonates), and producing suboptimal image quality (Ga-67 citrate scan). The role of FDG PET/CT in the evaluation of patients with sepsis of unknown origin is still unclear. The impact of FDG PET/CT was assessed according to the number of cases with treatment modifications based on the imaging results
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