title: Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia.
abstract: OBJECTIVE
  Levels of procalcitonin, midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal provasopressin (copeptin), and C-reactive protein (CRP), as well as Sequential Organ Failure Assessment (SOFA) scores, are associated with severity and described as predictors of outcome in ventilator-associated pneumonia (VAP). This study sought to compare the predictive value of these biomarkers for mortality in VAP.
  
  
  METHODS
  An observational study of 71 patients with VAP. Levels of procalcitonin, MR-proANP, copeptin, and CRP, together with SOFA scores, were determined at VAP onset, designated day 0 (D0), and on day 4 of treatment (D4). Patients received empirical antimicrobial therapy, with modifications based on culture results. Patients who died before D28 were classified as nonsurvivors.
  
  
  RESULTS
  Of the 71 patients evaluated, 45 were classified as survivors. Of the 45 survivors, 35 (77.8%) received appropriate antimicrobial therapy, compared with 18 (69.2%) of the 26 nonsurvivors (p = 0.57). On D0 and D4, the levels of all biomarkers (except CRP), as well as SOFA scores, were lower in eventual survivors than in eventual nonsurvivors. For D0 and D4, the area under the ROC curve was largest for procalcitonin. On D0, MR-proANP had the highest positive likelihood ratio (2.71) and positive predictive value (0.60), but procalcitonin had the highest negative predictive value (0.87). On D4, procalcitonin had the highest positive likelihood ratio (3.46), the highest positive predictive value (0.66), and the highest negative predictive value (0.93).
  
  
  CONCLUSIONS
  The biomarkers procalcitonin, MR-proANP, and copeptin can predict mortality in VAP, as can the SOFA score. Procalcitonin alone has the greatest predictive power for such mortality.
authors: Porto Alegre Hospital de Clínicas, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. reseligman@hcpa.ufrgs.br
authors: Renato
authors: R
authors: Seligman
authors: Beatriz Graeff Santos
authors: BG
authors: Seligman
authors: Paulo José Zimermann
authors: PJ
authors: Teixeira
mesh_terms: D019540:Area Under Curve; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001938:Brazil / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D005260:Female; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000401:mortality*; D036361:Peptide Hormones / Q000097:blood; D053717:Pneumonia, Ventilator-Associated / Q000097:blood / Q000401:mortality*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006020:Glycopeptides; D036361:Peptide Hormones; D011498:Protein Precursors; C048197:copeptins; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide