Decreases in procalcitonin and C-reactive protein are strong predictors of survival in ventilator-associated pneumonia.
BACKGROUND
This study sought to assess the prognostic value of the kinetics of procalcitonin (PCT), C-reactive protein (CRP) and clinical scores (clinical pulmonary infection score (CPIS), Sequential Organ Failure Assessment (SOFA)) in the outcome of ventilator-associated pneumonia (VAP) at an early time point, when adequacy of antimicrobial treatment is evaluated.


METHODS
This prospective observational cohort study was conducted in a teaching hospital. The subjects were 75 patients consecutively admitted to the intensive care unit from October 2003 to August 2005 who developed VAP. Patients were followed for 28 days after the diagnosis, when they were considered survivors. Patients who died before the 28th day were non-survivors. There were no interventions.


RESULTS
PCT, CRP and SOFA score were determined on day 0 and day 4. Variables included in the univariable logistic regression model for survival were age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, decreasing DeltaSOFA, decreasing DeltaPCT and decreasing DeltaCRP. Survival was directly related to decreasing DeltaPCT with odds ratio (OR) = 5.67 (95% confidence interval 1.78 to 18.03), decreasing DeltaCRP with OR = 3.78 (1.24 to 11.50), decreasing DeltaSOFA with OR = 3.08 (1.02 to 9.26) and APACHE II score with OR = 0.92 (0.86 to 0.99). In a multivariable logistic regression model for survival, only decreasing DeltaPCT with OR = 4.43 (1.08 to 18.18) and decreasing DeltaCRP with OR = 7.40 (1.58 to 34.73) remained significant. Decreasing DeltaCPIS was not related to survival (p = 0.59). There was a trend to correlate adequacy to survival. Fifty percent of the 20 patients treated with inadequate antibiotics and 65.5% of the 55 patients on adequate antibiotics survived (p = 0.29).


CONCLUSIONS
Measurement of PCT and CRP at onset and on the fourth day of treatment can predict survival of VAP patients. A decrease in either one of these marker values predicts survival.
Seligman
Renato
R
Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil. reseligman@hcpa.ufrgs.br
Meisner
Michael
M
Lisboa
Thiago C
TC
Hertz
Felipe T
FT
Filippin
Tania B
TB
Fachel
Jandyra M G
JM
Teixeira
Paulo J Z
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000037:antagonists & inhibitors* / Q000096:biosynthesis; D002116:Calcitonin / Q000037:antagonists & inhibitors* / Q000096:biosynthesis / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000401:mortality*; D011446:Prospective Studies; D011498:Protein Precursors / Q000037:antagonists & inhibitors* / Q000096:biosynthesis / Q000097:blood; D012121:Respiration, Artificial / Q000401:mortality; D015996:Survival Rate; D012122:Ventilators, Mechanical / Q000382:microbiology*
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide