title: Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography.
abstract: BACKGROUND
  To facilitate the clinical diagnosis of ventilator-associated pneumonia (VAP) in the ICU, the Clinical Pulmonary Infection Score (CPIS) has been proposed but has shown a low diagnostic performance in subsequent studies. We propose a new score based on procalcitonin level and chest echography with the aim of improving VAP diagnosis: the Chest Echography and Procalcitonin Pulmonary Infection Score (CEPPIS).
  
  
  METHODS
  This retrospective pilot study recruited patients admitted to the Intensive Care Unit of the Emergency Department, Careggi University Hospital (Florence, Italy), from January 2009 to December 2011. Patients were retrospectively divided into a microbiologically confirmed VAP group or a control group based on diagnosis of VAP and positive tracheal aspirate culture.
  
  
  RESULTS
  A total of 221 patients were included, with 113 in the microbiologically confirmed VAP group and 108 in the control group. A CEPPIS > 5 retrospectively fixed was significantly better in predicting VAP (OR, 23.78; sensitivity, 80.5%; specificity, 85.2%) than a CPIS > 6 (OR, 3.309; sensitivity, 39.8%; specificity, 83.3%). The receiver operating characteristic area under the curve analysis also showed a significantly higher diagnostic value for CEPPIS > 5 than CPIS > 6 (0.829 vs 0.616, respectively; P < .0001).
  
  
  CONCLUSIONS
  In this pilot, exploratory analysis, CEPPIS is effective in predicting VAP. Prospective validation is needed to confirm the potential value of this score to facilitate VAP diagnosis.
authors.affiliation: Anesthesia and Intensive Care Unit of the Emergency Department, Careggi University Hospital, Florence, Italy. Electronic address: giovanni.zagli@unifi.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zagli
authors.affiliation: Anesthesia and Intensive Care Unit of the Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Morena
authors.initials: M
authors.lastname: Cozzolino
authors.affiliation: Laboratory Department, Careggi University Hospital, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Terreni
authors.affiliation: Laboratory Department, Careggi University Hospital, Florence, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Biagioli
authors.affiliation: Laboratory Department, Careggi University Hospital, Florence, Italy.
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Caldini
authors.affiliation: Anesthesia and Intensive Care Unit of the Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016022:Case-Control Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide