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This Article Full Text (PDF) All Versions of this Article: chest.07-2546v1 134/1/101    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Pelosi, P. Articles by Niederman, M. S. PubMed PubMed Citation Articles by Pelosi, P. Articles by Niederman, M. S.

PROGNOSTIC ROLE OF CLINICAL AND LABORATORY CRITERIA TO IDENTIFY EARLY VAP IN BRAIN INJURY

¹ Servizio di Anestesia e Rianimazione B, Department of Ambient, Healthy and Safety, Università degli Studi dell'Insubria, Varese, Italy ² Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, Milano, Italy ³ Laboratorio di Analisi, Ospedale di Legnano, Legnano, Italy ⁴ Laboratorio di Biotecnologie, IRCCS Policlinico S. Matteo, Dipartimento di Biochimica, Università degli Studi di Pavia, Pavia, Italy ⁵ Department of Medicine, Winthrop- University Hospital, Mineola, NY, USA

ppelosi{at}hotmail.com

Abstract

BACKGROUND: We investigated the role of the Clinical Pulmonary Infection Score (CPIS), serum levels of Procalcitonin (PCT), C-Reactive Protein (CRP), and Serum Amyloid A (SAA) in the detection of patients who developed early Ventilator Associated Pneumonia (early VAP).

METHODS: Observational study in an University Hospital. In 58 severe brain injured mechanically ventilated patients, CPIS, PCT, CRP and SAA were evaluated at Intensive Care Unit entry and at the day 3-4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or broncho-alveolar lavage cultures).

RESULTS: We found that: 1) PCT at entry was increased in patients who later developed early VAP (25 patients) compared to no VAP [1.4 (0.14-0.78) vs 0.2 (0.76-2.4) ng/mL (median, 25^th-75^th percentiles), P<0.001; sensitivity 76% and specificity 75%); 2) CPIS score increased at the day of VAP diagnosis, compared to entry (6.6±1.1 vs 1.5±1.1, P<0.001; sensitivity 97% and specificity 100%), while other serum inflammatory markers did not change; 3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS score changes.

CONCLUSIONS: 1) PCT may be a useful marker to predict which patients subsequently developed early VAP; 2) CPIS score could help as an early way to detect the patients who develop early VAP and who need further diagnostic testing.

Key Words: Brain Injury • Clinical Infection Pulmonary Score • C-Reactive Protein • Procalcitonin • Serum Amyloid A • Ventilator Associated Pneumonia