The Diagnosis of Vascular Graft Infection using the Management Aortic Graft Infection Collaboration (MAGIC) Criteria: A Retrospective Validation Study
Mu'ath Adlouni, Raniyah Nathani, Ezra Koh, Oliver Lyons, Eric Peden, Maham Rahimi
Houston Methodist Hospital, Houston, TX
INTRODUCTION: Vascular graft infection (VGI) is a devastating complication that necessitates accurate diagnosis to reduce morbidity and mortality. In 2016, The Management of Aortic Graft Infection Collaboration (MAGIC) suggested a new standard diagnostic algorithm for identifying aortic graft infection. The MAGIC criteria makes use of clinical, radiological, and laboratory findings to determine the risk of aortic graft infection. The purpose of this study was to retrospectively validate the MAGIC criteria to various vascular grafts and potentially broaden its application for diagnosis of VGI.
METHODS: A retrospective cohort study was performed with 26 patients from our institution with prosthetic grafts, 14 aortic and 12 peripheral, with suspicion for VGI. A blinded chart review was then performed to categorize the patients based on MAGIC criteria into infected, suspected infection, or insufficient evidence to suspect infection using a Python generated application. Due to the MAGIC criteria’s placement of a third outcome, suspicion for infection, the results were divided into 2 categories whereby suspicion for infection was considered as infected (S=I) or not infected (S=NI). The results from the MAGIC criteria were then compared to the clinical diagnosis (infected or not infected graft) concluded from the blinded chart review, and sensitivity and specificity were calculated.
RESULTS: A total of 12 patients (46%) were diagnosed with VGI using the MAGIC criteria, 2 patients with suspected VGI, and 12 patients with insufficient evidence to suspect VGI. When using clinical diagnoses, 16 out of 26 had VGI (62%). When S=I, the sensitivity was 87.5% and specificity of 100%. Whereas when S=NI, the sensitivity dropped to 75% meanwhile the specificity remained at 100%. Further analysis could be completed with 23 of the 26 patients from the cohort due to their additional surgically confirmed VGI diagnosis. Using this new population category S=I, the sensitivity was calculated to be 84.46% with a specificity of 100%. Whereas when S=NI, the sensitivity was calculated to be 76.9% with specificity remaining at 100%.
CONCLUSIONS: The MAGIC criteria provide excellent specificity for diagnosis of VGI for peripheral and aortic revascularization. Further studies are needed to validate the use of MAGIC criteria for diagnosing VGI.
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