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Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia.

Tanrıverdi H, Tor MM, Kart L, Altın R, Atalay F, SumbSümbüloğlu V - Ann Thorac Med (2015 Apr-Jun)

Bottom Line: However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group.Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not.The PCT level on D3 was the strongest predictor of mortality in VAP.

View Article: PubMed Central - PubMed

Affiliation: Department of Chest Diseases, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey.

ABSTRACT

Introduction: Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP.

Methods: Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed.

Results: In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6.

Conclusion: Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP.

No MeSH data available.


Related in: MedlinePlus

Receiver operator characteristic (ROC) curve analysis and sensitivity, specificity of procalcitonin (PCT) for mortality in patients with ventilatory associated pneumonia
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Figure 1: Receiver operator characteristic (ROC) curve analysis and sensitivity, specificity of procalcitonin (PCT) for mortality in patients with ventilatory associated pneumonia

Mentions: In total, 45 patients with a mean age of 65.2 ± 16.1 (range, 19-87) years were included. Of them, 22 (48.8%) died before day 28 after pneumonia diagnosis. Five patients (11%) died before 7th day; thus, we could not obtained blood samples for PCT and CRP from these patients on D7. Demographic and descriptive data of patients at ICU admission were grouped according to survivors or non-survivors and are shown in Table 1. The most frequent cause of ICU admission was acute exacerbation of chronic obstructive pulmonary disease. Other causes of ICU admission included congestive heart failure, trauma, postoperative respiratory failure, and cerebrovascular diseases. The mean duration of mechanical ventilation was 8.5 ± 6.0 days in patients who developed VAP. The most frequently isolated microorganisms were Acinetobacter spp. (48.8%), followed by Pseudomonas aeruginosa (21%), methicillin-resistant Staphylococcus aureus (17%), and Gram-negative enteric bacteria (13%). Mean serum PCT levels on D3 and D7 were significantly higher in non-survivors than survivors (P < 0.001 and 0.002, respectively). However, there was no significant difference between the groups in mean serum PCT levels on D0 or CRP levels on D0, D3, or D7 [Table 2]. PCT kinetics differed significantly between the survivor and non-survivor groups from D0 to D3 (Δ1) and D0 to D7 [Δ2; P = 0.005 and 0.049, respectively; Table 3]. However, the difference between D3 and D7 was not significant (P = 0.842). Mean CRP levels decreased in both survivors and non-survivors from D0 to D7, but there was no statistically significant difference between the groups (P = 0.583). Mean APACHE II, SAPS II, and SOFA scores calculated at ICU admission were not statistically significantly different between the survivor and non-survivor groups. The “best” cut-off values for serum PCT levels for mortality, obtained from ROC curves [Figure 1], are shown in Table 4. A PCT level greater than 1 ng/mL on D3 was the strongest predictor of mortality, with an odds ratio of 22.6. Also different cut-off values, sensitivity and specificity values of PCT for mortality were calculated [Table 5]. After the multivariate regression analyse both PCT levels on D3 [Table 6] and PCT kinetics from D0 to D3 (data not shown) still remained independent risk factors for mortality with odds ratios 5.9 and 2.6, respectively.


Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia.

Tanrıverdi H, Tor MM, Kart L, Altın R, Atalay F, SumbSümbüloğlu V - Ann Thorac Med (2015 Apr-Jun)

Receiver operator characteristic (ROC) curve analysis and sensitivity, specificity of procalcitonin (PCT) for mortality in patients with ventilatory associated pneumonia
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4375743&req=5

Figure 1: Receiver operator characteristic (ROC) curve analysis and sensitivity, specificity of procalcitonin (PCT) for mortality in patients with ventilatory associated pneumonia
Mentions: In total, 45 patients with a mean age of 65.2 ± 16.1 (range, 19-87) years were included. Of them, 22 (48.8%) died before day 28 after pneumonia diagnosis. Five patients (11%) died before 7th day; thus, we could not obtained blood samples for PCT and CRP from these patients on D7. Demographic and descriptive data of patients at ICU admission were grouped according to survivors or non-survivors and are shown in Table 1. The most frequent cause of ICU admission was acute exacerbation of chronic obstructive pulmonary disease. Other causes of ICU admission included congestive heart failure, trauma, postoperative respiratory failure, and cerebrovascular diseases. The mean duration of mechanical ventilation was 8.5 ± 6.0 days in patients who developed VAP. The most frequently isolated microorganisms were Acinetobacter spp. (48.8%), followed by Pseudomonas aeruginosa (21%), methicillin-resistant Staphylococcus aureus (17%), and Gram-negative enteric bacteria (13%). Mean serum PCT levels on D3 and D7 were significantly higher in non-survivors than survivors (P < 0.001 and 0.002, respectively). However, there was no significant difference between the groups in mean serum PCT levels on D0 or CRP levels on D0, D3, or D7 [Table 2]. PCT kinetics differed significantly between the survivor and non-survivor groups from D0 to D3 (Δ1) and D0 to D7 [Δ2; P = 0.005 and 0.049, respectively; Table 3]. However, the difference between D3 and D7 was not significant (P = 0.842). Mean CRP levels decreased in both survivors and non-survivors from D0 to D7, but there was no statistically significant difference between the groups (P = 0.583). Mean APACHE II, SAPS II, and SOFA scores calculated at ICU admission were not statistically significantly different between the survivor and non-survivor groups. The “best” cut-off values for serum PCT levels for mortality, obtained from ROC curves [Figure 1], are shown in Table 4. A PCT level greater than 1 ng/mL on D3 was the strongest predictor of mortality, with an odds ratio of 22.6. Also different cut-off values, sensitivity and specificity values of PCT for mortality were calculated [Table 5]. After the multivariate regression analyse both PCT levels on D3 [Table 6] and PCT kinetics from D0 to D3 (data not shown) still remained independent risk factors for mortality with odds ratios 5.9 and 2.6, respectively.

Bottom Line: However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group.Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not.The PCT level on D3 was the strongest predictor of mortality in VAP.

View Article: PubMed Central - PubMed

Affiliation: Department of Chest Diseases, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey.

ABSTRACT

Introduction: Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP.

Methods: Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed.

Results: In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6.

Conclusion: Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP.

No MeSH data available.


Related in: MedlinePlus