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.
|Titolo:||Prognostic role of clinical and laboratory criteria to identify early vap in brain injury|
BARASSI, ALESSANDRA (Secondo)
|Parole Chiave:||Brain injury; C-reactive protein; Clinical infection pulmonary score; Procalcitonin; Serum amyloid A; Ventilator-associated pneumonia|
|Settore Scientifico Disciplinare:||Settore BIO/12 - Biochimica Clinica e Biologia Molecolare Clinica|
|Data di pubblicazione:||10-apr-2008|
|Digital Object Identifier (DOI):||10.1378/chest.07-2546|
|Appare nelle tipologie:||01 - Articolo su periodico|