title: Diagnostic Efficacy of Serum Amyloid A Protein and Soluble Intercellular Adhesion Molecule 1 in Pediatric Ventilator-Associated Pneumonia.
abstract: OBJECTIVE
  Study of inflammatory biomarkers which may aid in early detection of ventilator-associated pneumonia (VAP) in children and predicting their outcome.
  
  
  METHODS
  Thirty-five children, aged 2 months to 13 years, needed mechanical ventilation (MV) for more than 48 hours due to causes other than pneumonia.
  
  
  METHODS
  Measurement of serum amyloid A (SAA) protein, soluble intercellular adhesion molecule 1 (sICAM-1), and C-reactive protein (CRP), modified clinical pulmonary infection score (CPIS) and performing culture of endotracheal aspirate at the start and on the third day of MV.
  
  
  RESULTS
  Ventilator-associated pneumonia was diagnosed by CPIS in 6 (17.1%) of 35 patients. On the third day of MV, there was a significant increase in serum mean levels of SAA, sICAM-1, and CRP in comparison to the start of MV ( P = .005, .004, and .01, respectively). Three (50%) of 6 patients with VAP died, while 4 (14.28%) of 28 patients without VAP died. The sensitivity of serum SAA, sICAM-1, and CPIS were 100% for predicting VAP, while specificity was highest for CPIS (96.55%) followed by SAA (93.1%). Combination of CPIS and SAA increased the specificity to 100%. For predicting nonsurvival, serum SAA and sICAM-1 had a sensitivity of 100% and a specificity of 92.86% and 89.29%, respectively.
  
  
  CONCLUSIONS
  Serum amyloid A and sICAM-1 may be considered as reliable markers for detection of VAP. Combination of serum SAA with CPIS increased the specificity to 100%. Measurement of SAA in patients with VAP also had a good predictive value for nonsurvival in such patients.
authors.affiliation: 1 Pediatric Intensive Care Unit, Faculty of Medicine, Pediatric Department, Tanta University, Gharbia Governorate, Tanta, Egypt.
authors.forename: Hamdy H
authors.initials: HH
authors.lastname: Abo-Hagar
authors.affiliation: 1 Pediatric Intensive Care Unit, Faculty of Medicine, Pediatric Department, Tanta University, Gharbia Governorate, Tanta, Egypt.
authors.forename: Ahmed Abd ElBasset
authors.initials: AAE
authors.lastname: Abo-Elezz
authors.affiliation: 1 Pediatric Intensive Care Unit, Faculty of Medicine, Pediatric Department, Tanta University, Gharbia Governorate, Tanta, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Mehrez
authors.affiliation: 2 Clinical Pathology Department, Tanta University, Gharbia Governorate, Tanta, Egypt.
authors.forename: Maaly M
authors.initials: MM
authors.lastname: Mabrouk
authors.affiliation: 2 Clinical Pathology Department, Tanta University, Gharbia Governorate, Tanta, Egypt.
authors.forename: Ola A
authors.initials: OA
authors.lastname: Elshora
mesh_terms: D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004534:Egypt; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D000685:Serum Amyloid A Protein / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D000685:Serum Amyloid A Protein; D018799:Intercellular Adhesion Molecule-1
keywords: CPIS; ETA; SAA; VAP; soluble ICAM-1