Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury.
BACKGROUND
We investigated the role of the clinical pulmonary infection score (CPIS), serum levels of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in the detection of patients with early ventilator-associated pneumonia (VAP).


METHODS
Observational study in a university hospital. In 58 patients with severe brain injury receiving mechanical ventilation, CPIS, PCT, CRP and SAA were evaluated at ICU entry and at days 3 to 4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or BAL cultures).


RESULTS
We found the following: (1) PCT at entry was increased in patients who later had early VAP develop (25 patients) compared to no VAP (median, 1.4 ng/mL; 25-75 percentiles, 0.14-0.78; vs median, 0.2 ng/mL; 25-75 percentiles, 0.76-2.4, p<0.001; sensitivity, 76%; and specificity, 75%); (2) CPIS increased at the day of VAP diagnosis, compared to entry (median, 6.6+/-1.1 vs 1.5+/-1.1, p<0.001; sensitivity, 97%; specificity, 100%), while other serum inflammatory markers did not change; and (3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS changes.


CONCLUSIONS
PCT may be a useful marker to predict which patients subsequently have early VAP. The CPIS could help as an early way to detect the patients with early VAP and who need further diagnostic testing.
Pelosi
Paolo
P
Servizio di Anestesia B, Ospedale di Circolo e Fondazione Macchi, viale Borri 57, 21100, Varese, Italy. ppelosi@hotmail.com
Barassi
Alessandra
A
Severgnini
Paolo
P
Gomiero
Barbara
B
Finazzi
Sergio
S
Merlini
Giampaolo
G
d'Eril
GianVico Melzi
GM
Chiaranda
Maurizio
M
Niederman
Michael S
MS
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000628:therapy*; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000097:blood* / Q000175:diagnosis* / Q000382:microbiology; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000685:Serum Amyloid A Protein / Q000378:metabolism*; D012122:Ventilators, Mechanical / Q000009:adverse effects* / Q000382:microbiology
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D000685:Serum Amyloid A Protein; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide