Potential usefulness of FDG PET/CT in patients with sepsis of unknown origin

• Published in: PloS one 2013-06, Vol.8 (6), p.e66132-e66132
• Main Authors: Tseng, Jing-Ren, Chen, Ke-Yuan, Lee, Ming-Hsun, Huang, Ching-Tai, Wen, Ying-Hao, Yen, Tzu-Chen
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alkaline phosphatase; Aspartate; Aspartate aminotransferase; Care and treatment; Computed tomography; Confidence intervals; Diagnosis; Female; Fluorodeoxyglucose F18; Hospitals; Humans; Imaging; Infection; Infections; Infectious diseases; Internal medicine; Kidney diseases; Laboratories; Liver cirrhosis; Logistic Models; Male; Medical imaging; Medical research; Medicine; Metabolism; Metastasis; Middle Aged; NMR; Nuclear magnetic resonance; Nuclear medicine; Patients; Phosphatase; Phosphatases; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Regression analysis; Retrospective Studies; Sepsis; Sepsis - diagnosis; Sepsis - diagnostic imaging; Statistical analysis; Tomography; Tomography, X-Ray Computed - methods
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0066132

The 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. A 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. Of 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. Our 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.