The Diagnostic and Prognostic Value of Serum Procalcitonin among Ventilator Associated Pneumonia Patients*

Abstract

Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value < 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p < 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p < 0.01) between mortality prediction scores (APACHE II (R = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.

The Importance of Serum Procalcitonin in Diagnosis and Treatment of Serious Bacterial Infections and Sepsis

“…3 ). The authors concluded that the increase of serum procalcitonin is an important diagnostic marker in identifying and predicting the outcome of VAP, and its usefulness is confirmed by the result of many other studies ( 23 , 24 , 25 ).…”

“…Clinical symptoms and chest radiogram in the first phase of VAP development are not typical, and etiological significance of microbial isolates from tracheobronchial secretion is questionable, with regard to the expected colonization of respiratory pathogens. El Halim et al ( 23 ) compared the mean values of PCT in the group of VAP-patients (n = 42), with values in patients on mechanical ventilation without VAP (n = 20) and control group of healthy patients (n = 20). They demonstrated a significantly higher PCT values (p <0.001) in the VAP group (1.54 ± 0.50 ng / ml), compared to patients without VAP (0.06 ± 0.03 ng / ml) and patients of control group (0.04 ± 0.02 ng / ml) (Fig.…”

“… Comparison between the different subject groups re-garding initial PCT levels (ng/ml), adapted from ( 23 ). PCT 1st day PCT 5th day.…”

“… Comparison between the survivor and died groups among VAP patients (first and 5th days respectively), adapted from ( 23 ). …”

Procalcitonin: In diagnosis of paediatric infections

“…• It is used for assisting the prognosis of severe localised infections such as pneumonia [19] • In critically ill patients with systemic infection helps in explaining the prognosis • As well as in starting antibiotics in case of elevated PCT, its normal level can guide us to discontinuing antibiotics, this will reduce antibiotic use and help in antimicrobial stewardship. [20] PROGNOSTIC VALUE OF PCT…”