Diagnostic efficacy of serum procalcitonin, C-reactive protein concentration and clinical pulmonary infection score in Ventilator-Associated Pneumonia

Abstract

> Objective: The aim of this study was to evaluate the diagnostic efficacy of serum procalcitonin (PCT), c-reactive protein (CRP) concentration and clinical pulmonary infection score(CPIS) in ventilator-associated pneumonia(VAP). Methods: Fortynine patients who were admitted to the intensive care unit (ICU) of Zhejiang Hospital with suspected VAP were recruited in this study. The serum level of PCT and CRP of all patients were measured and CPIS was calculated at the time of VAP suspected diagnosis. Of the included 49 patients, 24 were finally confirmed of VAP by microbiology assay. And the other 25 patients were considered as clinical suspected VAP without microbiology confirmation. The diagnostic sensitivity, specificity and area under the receiver operating characteristic (ROC) curve (AUC) were calculated using the serum PCT, CRP concentration and CPIS. The correlation among serum PCT, CRP concentration and CPIS were also evaluated by Spearson correlation test. Results: A total of 100 bronchoscopic aspiration sputum specimen were examined in bacterial culture. 30 samples were found with suspected pathogenic bacteria. Six samples were found with 2 types of suspected pathogenic bacteria. PCT serum concentration and CPIS score were significantly different (P<0.05) between the patient group [1.4 (0.68 ∼ 2.24), 6.0 (4.25 ∼ 8.00)] and the control group [0.4 (0.17 ∼ 1.39), 3.0 (1.00 ∼ 5.00)] ; However, the serum CRP [102.8(66.75 ∼ 130.90) vs 86.1(66.95 ∼ 110.10)] was not statistically different between the two groups (P>0.05). A significant correlation was found between serum PCT and CRP concentrations (r=0.55, P<0.01), but not between PCT vs CPIS and CRP vs CPIS (p>0.05). The diagnostic sensitivity, specificity and AUC were 72.0%, 75.0%, 0.81 (0.69 ∼ 0.93) for CPIS; 60.0%, 87.5%, 0.76 (0.62 ∼ 0.90) for PCT and 68.0%, 58.3%, 0.59 (0.43 ∼ 0.76) for CRP. Conclusion: PCT serum level and CPIS score are elevated in VAP patients and could therefore represent potential biomarkers for VAP early diagnosis. <

Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

“…Forty-three of the studies were cohort studies (38 of which were prospective studies) and one was a secondary analysis of data from a randomised controlled trial (RCT) [ 57 ]. All studies were published between 2008 and 2018 with a wide geographical spread; four studies conducted in the UK [ 41 , 44 , 72 , 74 ], eight in the USA [ 40 , 45 , 47 , 50 , 56 , 62 , 67 , 75 ], seven in France [ 51 , 53 , 55 , 63 , 70 , 73 , 78 ], five in Netherland [ 48 , 61 , 66 , 77 , 79 ], three each in both China [ 52 , 65 , 68 ] and Turkey [ 43 , 46 , 82 ], two each in Egypt [ 49 , 76 ], Brazil [ 54 , 81 ], and Italy [ 71 , 83 ], and eight in other countries [ 42 , 57 – 60 , 64 , 69 , 80 ]. The median sample size was 180 recruited participants, with the 21 being the lowest [ 58 ] and 2080 being the highest number of participants [ 61 ] (see Tables 2 , 3 ).…”

“…Table 3 summarises the remaining 12/44 (27.2%) studies which compared an index test to a composite reference standard or clinical scoring system [ 44 , 52 , 53 , 61 , 62 , 64 , 68 , 71 , 72 , 78 , 80 , 81 ]. An iteration of the CDC VAP definition was used in two out of the 12 studies (16.7%), one using the 2008 iteration for surveillance of VAP [ 62 ] and one using the 2015 iteration for surveillance of VAP (80].…”

Diagnostic approaches of pneumonia for commercial-scale biomedical applications: an overview

“…(1) high CRP values in pneumonia patients with S. pneumoniae or L. pneumophila; (2) increased CRP values with the severity of disease showing the use of CRP in pneumonia prognosis; (3) the use of CRP for the commencement of treatment procedure (Mendelson et al 2018). CRP values are higher in certain pathogens than others and cannot differentiate viral from bacterial pneumonia (Chen et al 2018a). Also, CRP does not allow for the distinguishing between all the types of pneumonia, its sensitivity is questionable.…”

Monocyte Chemoattractant Protein-1, a Possible Biomarker of Multiorgan Failure and Mortality in Ventilator-Associated Pneumonia

“…The clinical pulmonary infection score (CPIS) is often used as a diagnostic tool for VAP; however, both its sensitivity and its specificity are unsatisfactory, particularly in predicting the severity of VAP. Thereafter, it was modified and used for guiding therapy [9,17,18,19,20]. Another scoring system based on the VAP PIRO (predisposition, insult response and organ dysfunction) concept and IBMP-10 (immunodeficiency, blood pressure, multilobular infiltrates on chest radiograph, platelets and hospitalization 10 days before onset of VAP) was developed.…”

“…MCP-1 has been demonstrated to be deeply involved in the protection against bacterial infection and also participates in lung-protective immunity. Many previous studies examined the severity of pneumonia and discovered that it is both reflected and predicted by higher levels of cytokines in the blood [16,19,20,21,22]. For instance, in patients with community-acquired pneumonia [4], MCP-1 levels were shown to be correlated with disease severity.…”