[Value of the clinical pulmonary infection score for the prognosis of ventilator-associated pneumonia].
OBJECTIVE
To prospectively evaluate the performance of the clinical pulmonary infection score (CPIS) and its prognostic value for early onset ventilator-associated pneumonia (VAP).


METHODS
The clinical data of 62 cases with VAP in the respiratory intensive care unit (RICU) were studied. The CPIS score was calculated at 3 days before the onset of VAP (VAP-3), at the onset of VAP (VAP+1), and at 3 (VAP+3), 5 (VAP+5), and 7 (VAP+7) days after onset, and the pathogens were examined.


RESULTS
A significant higher CPIS score was found at the onset of VAP (VAP+1) 7.2 +/- 1.5, and at 3 (VAP+3) 7.3 +/- 1.3, 5 (VAP+5) 7.0 +/- 2.1, and 7 (VAP+7) 5.8 +/- 3.5 days after onset compared with at 3 days before VAP (VAP-3) 3.3 +/- 1.1 (P < 0.01). An increase of CPIS was significant in nonsurvivors at the onset of VAP (VAP+1) 7.4 +/- 1.8, and at 3 (VAP+3) 7.7 +/- 1.5, 5 (VAP+5) 8.5 +/- 1.4, and 7 (VAP+7) 8.9 +/- 1.4 days after onset compared with at 3 days before VAP (VAP-3) (3.6 +/- 1.1) (P < 0.01). An increase in CPIS was also significant in survivors at the onset of VAP (VAP+1) 6.9 +/- 1.0, at 3 (VAP+3) 6.9 +/- 1.1, and 5 (VAP+5) 5.5 +/- 1.6 day after onset compared with at 3 days before VAP (VAP-3) 3.1 +/- 1.1 (P < 0.01), but the decrease in CPIS was significant at 7 (VAP+7) 2.7 +/- 1.8 day after VAP onset (P < 0.01). In patients with a CPIS > 6 at 5 days after VAP onset, the mortality was higher than those with a CPIS < 6 (P = 0.00). The sensitivity and specificity of predicted mortality was 96.8 percent and 74.2 percent respectively. There was a significant correlation between CPIS score and length of mechanical ventilation (r = 0.526, P = 0.00) and length of respiratory intensive care unit stay (r = 0.449, P = 0.00) and the length of hospital stay (r = 0.519, P = 0.00). Patients receiving adequate therapy showed a slight fall in CPIS at VAP+5, whereas those with inadequate therapy did not.


CONCLUSIONS
Serial measurement of CPIS is valuable in predicting the severity of illness and evaluating the effect of therapy and prognosis.
Yang
Guo-hui
GH
Department of Respiratory Medicine, Peking University First Hospital, Beijing 100034, China.
Wang
Guang-fa
GF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012720:Severity of Illness Index