Possible improvement of tissue donor potential by better definition and diagnosis of active systemic infection or sepsis

J.W. van der Veer, E.M.W. Jager, B. Knaake, A. Broeks, R. Bannink, R. Brohet, J.J. Haringman

Friday 16 march 2018

11:30 - 11:40h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 15: Clinical

Aim

This study aims to determine how often patients are excluded from tissue donation due to inaccurately supposed systemic infection or sepsis, to see to what extent the existing donation potential might be improved.

Methods

Retrospective review of medical records of all adults under 86 who were excluded from tissue donation in 2015 in our institution (N=96) due to supposed active systemic infection/sepsis. Patients who met other exclusion criteria for tissue donation were excluded (N=23). Primary outcome was the presence of an active systemic infection or sepsis treated

Results

In total, 73 patients were included in the study. Cohen’s kappa between the two initial raters was high (κ=0.68, N=57). Cohen’s kappa between the two initial raters and the third rater, on cases with one rating of the two initial raters, was also high (κ=1.00, N=5; K=1.00, N=7). In twenty patients (27%) there was no systemic infection at date of death. Univariate analysis showed that absence of systemic infection was associated with a last measurement of CRP≤100mg/L (p<0.001), no antibiotics prescribed at last day of non-palliative treatment (p<0.001), and absence of systemic inflammatory response syndrome (SIRS) two days before death (p=0.02) defined conform the model protocol of the NTS. In a multivariate analysis, only absence of SIRS two days before death presented as an independent negative predictor of systemic infection (OR=0.07 [95%CI:0.07-0.71]; p=0.02) with an AUC of 0.79 [95%CI:0.59-0.99].

Conclusion

Among patients excluded from tissue donation, there is a substantial proportion without a systemic infection that make them in retrospect suitable for tissue donation. This may be due to the ambiguity of the used definitions for systemic infection and beneficial response to antibiotic treatment.