title: Plasminogen activation inhibitor concentrations in bronchoalveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients.
abstract: OBJECTIVE
  To compare the ability of four biomarkers to distinguish between those with ventilator-associated pneumonia (VAP) vs. lower respiratory tract bacterial colonization in mechanically ventilated intensive care unit (ICU) pediatric patients.
  
  
  METHODS
  Prospective, pilot cohort study.
  
  
  METHODS
  Tertiary care children's hospital, pediatric ICU.
  
  
  METHODS
  All pediatric ICU patients mechanically ventilated > 48 hrs were eligible for enrollment between April 2006 to May 2007. Thirty-three patients were consecutively screened and enrolled after institutional consent process.
  
  
  METHODS
  None.
  
  
  RESULTS
  VAP was defined by both Centers for Disease and Prevention/National Nosocomial Infections Surveillance criteria and clinician diagnosis; those not meeting the criteria were considered to be colonized. Plasminogen activation inhibitor (PAI-1), soluble triggering receptor expressed on myeloid cells, receptor for advanced glycation end-products, and surfactant protein D levels were measured in bronchoalveolar lavage samples on average within 24 hrs of suspicion for VAP, i.e., a positive screening endotracheal Gram stain. Sixteen patients were diagnosed with VAP and 17 met the criteria for colonization. PAI-1 was associated with VAP independent of age, sex, race, acute lung injury/acute respiratory distress syndrome, Pediatric Risk of Mortality 3 score, pediatric logistic organ dysfunction score, and duration of intubation. The receiver operating characteristics for PAI-1 showed good discrimination with an area under the curve of 0.82. PAI-1 levels of ≥ 2.8 ng/mL had a sensitivity of 81.3%, specificity of 76.5%, and positive likelihood ratio of 3.5. Levels of soluble triggering receptor expressed on myeloid cells, receptor for advanced glycation end-products, and surfactant protein D were not significantly associated with VAP.
  
  
  CONCLUSIONS
  In mechanically ventilated pediatric ICU patients, PAI-1 is independently associated with the diagnosis of VAP. Real-time measurement of PAI-1 levels in bronchoalveolar lavage fluid may be of benefit in the early diagnosis and subsequent treatment of VAP in ICU patients.
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA. rsrinivasan2004@yahoo.com
authors.forename: Ramya
authors.initials: R
authors.lastname: Srinivasan
authors.forename: Yuanlin
authors.initials: Y
authors.lastname: Song
authors.forename: Jeanine
authors.initials: J
authors.lastname: Wiener-Kronish
authors.forename: Heidi R
authors.initials: HR
authors.lastname: Flori
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis; D010865:Pilot Projects; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D037663:Pulmonary Surfactant-Associated Protein D / Q000032:analysis; D012372:ROC Curve; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000032:analysis; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008562:Membrane Glycoproteins; D017395:Plasminogen Activator Inhibitor 1; D037663:Pulmonary Surfactant-Associated Protein D; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1