title: The Role of Bronchoscopic Findings and Bronchoalveolar Lavage Fluid Cytology in Early Diagnosis of Ventilator-Associated Pneumonia.
abstract: BACKGROUND
  Early diagnosis of ventilator-associated pneumonia (VAP) is necessary to reduce morbidity and improve survival of critically ill patients in the ICU. The purpose of the present study is to examine the performance of macroscopic bronchoscopic findings and cytological analysis of bronchoalveolar lavage fluid (BALF) as an early diagnostic tool for VAP, either alone or in combination with clinically oriented scores (modified Clinical Pulmonary Infection Score [CPIS] or Johanson criteria).
  
  
  METHODS
  BAL was performed in 54 consecutive mechanically ventilated subjects. The predictive value of isolated or combined clinical characteristics, BALF, and/or other laboratory measurements in diagnosing VAP was analyzed by logistic regression analysis. A separate diagnostic score was derived from a linear combination of independent variables included in the multivariate model and compared with CPIS, Johanson criteria, and their combinations with BALF cytology (receiver operating characteristic curve analysis).
  
  
  RESULTS
  Integrating relative neutrophil cell count in CPIS or Johanson criteria optimized their specificity (>80%) but decreased sensitivity (<70%). Radiographic progression and the presence of distal purulent secretions on bronchoscopy were independently associated with VAP diagnosis. A new score that incorporates clinical, radiographic, and early bronchoscopic findings presented excellent diagnostic accuracy (area under curve = 0.96, sensitivity 94.3%, specificity 84.2%).
  
  
  CONCLUSIONS
  The diagnostic performance of classical clinical scores for VAP did not improve after combination with BALF cytology. A new composite score proved to be more accurate than previous scores in early VAP diagnosis.
authors.affiliation: Intensive Care Unit, Laiko General Hospital, Athens, Greece.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Vernikos
authors.affiliation: Intensive Care Unit, Laiko General Hospital, Athens, Greece. chkamp77@gmail.com.
authors.forename: Christos F
authors.initials: CF
authors.lastname: Kampolis
authors.affiliation: Hematology Department and Bone Marrow Transplantation Unit, University of Athens Medical School, Laiko General Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Konstantopoulos
authors.affiliation: Second University Department of Intensive Care Medicine, University of Athens Medical School, Attiko University Hospital, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.affiliation: Department of Cytopathology, University of Athens Medical School, Attiko University Hospital, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Karakitsos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D001999:Bronchoscopy / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D012372:ROC Curve; D012131:Respiratory Insufficiency / Q000628:therapy; D012680:Sensitivity and Specificity; D012122:Ventilators, Mechanical / Q000009:adverse effects
keywords: Johanson criteria; bronchoalveolar lavage (BAL); bronchoscopy; clinical pulmonary infection score (CPIS); mechanical ventilation; ventilator-associated pneumonia (VAP)