RESUMEN
Objectives: To present a series of immunosuppressed patients (oncohematological disease, congenital immunosuppression, hematopoietic stem cell (HSCT), and solid organ transplant) assisted on ECMO. Method(s): Descriptive, retrospective study (2011-2020) of a cohort of 9 immunosuppressed patients, supported on ECMO. Medical records were reviewed and demographic, clinical, and analytical variables were collected. Result(s): In our series of 9 patients, 5 were male, the median age was 8 years [RIC 3-11 years]. Considering the underlying disease, 6 were oncologic, 1 liver transplant and 2 with congenital immunodeficiency after HSCT. 4 were under active chemotherapy (median 6 days after the last cycle [RIC 5-188]). 6 were admitted due to acute respiratory failure, 3 due to hemodynamic instability (3/9), (one septic shock). The median PEEP was 12 [RIC 9-15] and FiO2 100% (81-100%). 78% (6) required vasoactive drugs (median inotropic score 35 [RIC 0-75]. 40%. 5 had severe neutropenia and/or plateletopenia in the 24 hours prior to ECMO, and alterations in acid-base balance (median pH 7. 1 [RIC 6.9-7.15]. 5 were on multiorgan failure. TPrimary ECMO transport was performed in 4 patients (44%). Cannulation was peripheral in 80% (57% cervical, 43% femoral) and central in 20%;70% VA-ECMO. Median time of assistance was 15 days [RIC 3.5-31.5] in cardiac ECMO (4), and 29 days [RIC 13.5-42] and in pulmonary ECMO (n=5). The median total time of admission was 45 days [RIC 27-59]. 9 had an infection, 2 COVID after HSCT, and 8 bleeding complications, but only one required surgical revision. Renal replacement therapy was used in 5 (median 9 days [RIC 5-34.5]). Other therapies used were polymyxin hemadsorption(2), intratracheal surfactant(2), plasma exchange(1), infusion of mesenchymal cells(1) and specific memory T lymphocytes(2). 4 patients died, 5 survived decannulation, 2 died later, with an overall survival rate to hospital discharge of 33% (3/9). Conclusion(s): Despite having a worse prognosis, ECMO can increase survival in immunosuppressed patients, in situations that are challenging and require a multidisciplinary approach.
RESUMEN
Background: The accuracy of rapid antigen tests (RAT) SARS-CoV-2 for in children is unknown. Our aim was to determine the diagnostic accuracy and concordance of the RAT PanBioTM (Abbott) compared to RT-PCR in nasopharyngeal smear (NPS) samples, in symptomatic pediatric population. Methods: This is a descriptive, retrospective, multicentre clinical study nested in a prospective, observational, multicenter cohort study. We included pediatric patients aged 0 to 16 years with symptoms consistent with COVID-19 of ≤5 days of evolution, attended in the Emergency Departments of the seven centers involved. A total of two consecutive NPS were obtained from each patient: one was employed to perform the RAT and the other to perform RT-PCR. Sample size for a non-inferiority study was calculated considering 80% power, for a 5% prevalence and a 90% sensitivity, using RT-PCR as the gold standard reference. A confusion matrix was displayed. Non-inferiority of sensitivity and specificity between diagnostic tests was assessed using the McNemar's test. The agreement between the two methods was calculated using Cohen's kappa index. Results: A total of 1620 patients were tested in 7 hospitals. The overall sensitivity for RAT PanBioTM was 45.4% (95%CI, 34.1-57.2), and specificity was 99.8% (95%CI, 99.4-99.9) (Figure 1). The positive predictive value (PPV) for this 4.8% prevalence was 92.5% (95%CI, 78.6-97.4). The negative predictive value was 97.3 % (95%CI, 96.8-97.8). Positive likelihood ratio (PLR) was high - 233.8 (IC 95%, 73.5-743.3), and negative likelihood ratio (NLR) was low - 0.54 (95%CI, 0.44-0.67). Conclusion: Compared to RT-PCR, the sensitivity of the RAT PanBioTM was low in children with <5 days of symptoms of COVID-19. The specificity and PLR were good, and the NLR and concordance with RT-PCR were only moderate. These results suggest that the test is very good when the result is positive, and that the test has only a limited value when the result is negative. In relation with screening and public health policy, these results should be interpreted considering also rapidness, availability and false positives ratio compared to RT-PCR or other tests.