Decreases in procalcitonin and C-reactive protein are strong predictors of survival in ventilator-associated pneumoniaReportar como inadecuado




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Critical Care

, 10:R125

First Online: 06 September 2006Received: 15 July 2006Accepted: 06 September 2006

Abstract

IntroductionThis study sought to assess the prognostic value of the kinetics of procalcitonin PCT, C-reactive protein CRP and clinical scores clinical pulmonary infection score CPIS, Sequential Organ Failure Assessment SOFA in the outcome of ventilator-associated pneumonia VAP at an early time point, when adequacy of antimicrobial treatment is evaluated.

MethodsThis prospective observational cohort study was conducted in a teaching hospital. The subjects were 75 patients consecutively admitted to the intensive care unit from October 2003 to August 2005 who developed VAP. Patients were followed for 28 days after the diagnosis, when they were considered survivors. Patients who died before the 28th day were non-survivors. There were no interventions.

ResultsPCT, CRP and SOFA score were determined on day 0 and day 4. Variables included in the univariable logistic regression model for survival were age, Acute Physiology and Chronic Health Evaluation APACHE II score, decreasing ΔSOFA, decreasing ΔPCT and decreasing ΔCRP. Survival was directly related to decreasing ΔPCT with odds ratio OR = 5.67 95% confidence interval 1.78 to 18.03, decreasing ΔCRP with OR = 3.78 1.24 to 11.50, decreasing ΔSOFA with OR = 3.08 1.02 to 9.26 and APACHE II score with OR = 0.92 0.86 to 0.99. In a multivariable logistic regression model for survival, only decreasing ΔPCT with OR = 4.43 1.08 to 18.18 and decreasing ΔCRP with OR = 7.40 1.58 to 34.73 remained significant. Decreasing ΔCPIS was not related to survival p = 0.59. There was a trend to correlate adequacy to survival. Fifty percent of the 20 patients treated with inadequate antibiotics and 65.5% of the 55 patients on adequate antibiotics survived p = 0.29.

ConclusionMeasurement of PCT and CRP at onset and on the fourth day of treatment can predict survival of VAP patients. A decrease in either one of these marker values predicts survival.

AbbreviationsAPACHEAPACHE = Acute Physiology and Chronic Health Evaluation

CPISCPIS = clinical pulmonary infection score

CRPCRP = C-reactive protein

ICUICU = intensive care unit

HCPAHCPA = Hospital de Clínicas de Porto Alegre

OROR = odds ratio

PCTPCT = procalcitonin

QEAQEA = quantitative endotracheal aspirate

SOFASOFA = Sequential Organ Failure Assessment

VAPVAP = ventilator-associated pneumonia.

Electronic supplementary materialThe online version of this article doi:10.1186-cc5036 contains supplementary material, which is available to authorized users.

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