title: Pancreatic stone protein: a marker of organ failure and outcome in ventilator-associated pneumonia.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is the most common hospital-acquired, life-threatening infection. Poor outcome and health-care costs of nosocomial pneumonia remain a global burden. Currently, physicians rely on their experience to discriminate patients with good and poor outcome. However, standardized prognostic measures might guide medical decisions in the future. Pancreatic stone protein (PSP)/regenerating protein (reg) is associated with inflammation, infection, and other disease-related stimuli. The prognostic value of PSP/reg among critically ill patients is unknown. The aim of this pilot study was to evaluate PSP/reg in VAP.
  
  
  METHODS
  One hundred one patients with clinically diagnosed VAP were assessed. PSP/reg was retrospectively analyzed using deep-frozen serum samples from VAP onset up to day 7. The main end point was death within 28 days after VAP onset.
  
  
  RESULTS
  Serum PSP/reg was associated with the sequential organ failure assessment score from VAP onset (Spearman rank correlation coefficient 0.49 P < .001) up to day 7. PSP/reg levels at VAP onset were elevated in nonsurvivors (n = 20) as compared with survivors (117.0 ng/mL [36.1-295.3] vs 36.3 ng/mL [21.0-124.0] P = .011). The areas under the receiver operating characteristic curves of PSP/reg to predict mortality/survival were 0.69 at VAP onset and 0.76 at day 7. Two PSP/reg cutoffs potentially allow for identification of individuals with a particularly good and poor outcome. Whereas PSP/reg levels below 24 ng/mL at VAP onset were associated with a good chance of survival, levels above 177 ng/mL at day 7 were present in patients with a very poor outcome.
  
  
  CONCLUSIONS
  Serum PSP/reg is a biomarker related to organ failure and outcome in patients with VAP.
  
  
  BACKGROUND
  ISRCTN.org; No.: ISRCTN61015974; URL: www.isrctn.org.
authors.affiliation: Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Lucas
authors.initials: L
authors.lastname: Boeck
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Rolf
authors.initials: R
authors.lastname: Graf
authors.affiliation: Department of Adult Critical Care Medicine, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Pargger
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Raptis
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Smyrnios
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Nehal
authors.initials: N
authors.lastname: Thakkar
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Siegemund
authors.affiliation: Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Janko
authors.initials: J
authors.lastname: Rakic
authors.affiliation: Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.affiliation: Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland. Electronic address: dstolz@uhbs.ch.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D051847:Lithostathine / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D051847:Lithostathine