Clinical usefulness of 18F-FDG PET/CT for the detection of infections of unknown origin in patients undergoing maintenance hemodialysis

Abstract

Patients with end-stage renal disease undergoing maintenance hemodialysis (MHD) are highly prone to infections. The potential clinical usefulness of 18F-FDG PET/CT for the detection of infections of unknown origin in this patient population remains unclear. This study was designed to investigate this issue. Methods: Between October 2011 and July 2014, a total of 104 adult MHD patients with sepsis underwent 18F-FDG PET/CT for the detection of unknown infection foci. Follow-up was continued until October 2014. Positive 18F-FDG PET/CT findings and mortality served as the main outcome measures. Results: Of the 104 study patients, 73 (70.2%) had positive 18F-FDG PET/CT findings, and a total of 95 major infection foci were identified. Eighteen patients (24.6%) had at least 2 infection foci on 18F-FDG PET/CT scans. Seven (53.8%) of the 13 patients with primary vascular access-related infections had concurrent metastatic foci. Twenty-eight patients (26.9%) had their treatments modified by 18F-FDG PET/CT results. Multivariate logistic regression analysis demonstrated that low hemoglobin and high C-reactive protein levels at diagnosis were the independent predictors of positive 18F-FDG PET/CT results. Twenty-seven patients (26.0%) died during their hospital stay, and 24 of them had positive 18F-FDG PET/CT findings (P 5 0.014). Positive 18F-FDG PET/CT results were an independent predictor of mortality (hazard ratio, 3.896; 95% confidence interval, 1.039-14.613; P 5 0.044). Conclusion: Our results suggest that 18F-FDG PET/CT may be clinically useful for detecting occult infection foci in end-stage renal disease patients undergoing MHD. In this population, positive 18F-FDG PET/CT findings may lead to a significant change in clinical management and independently predict mortality.