Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associated
pneumonia ( VAP) .
Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.
Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved.
Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.
Citation：
YIN Huiming,YANG Hongliang,LIU Jimin,ZHOU Mudan. Diagnostic Value of Procalcitonin and Percentage of Infected Cells in Identifying Early Ventilatorassociated Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(5): 454-456. doi: DOI: 10 . 7507 /1671 -6205 . 20130109
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med, 2002, 165: 867-903.
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American Thoracic Society, Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
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Safdar N, Dezfuhan C, Collard HR. et al. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med, 2005, 33 : 2184 -2193.
|
| 4. |
Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a Meta-analysis. J Crit Care, 2008, 23 :91-100.
|
| 5. |
Luna CM, Aruj P, Niederman MS, et al. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur Respir J,2006, 27: 158-164 .
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Rea-Neto A, Youssef NC, Tuche F, et al. Diagnosis of ventilatorassociated pneumonia: a systematic review of the literature. Crit Care, 2008, 12: R56.
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Lisboa T, Rello J. Diagnosis of ventilator-associated pneumonia: is there a gold standard and a simple approach? Curt Opin Infect Dis, 2008, 21: 174-178 .
|
| 8. |
Wilke MH, Grube RF, Bodmann KF. The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients-a DRG-based simulation mode. Eur J Med Res, 2011, 16: 543-548 .
|
| 9. |
Allaouchiche B, Jaumain H, Dumontet C, et al. Early diagnosis of ventilator-associated pneumonia : is it possible to define a cutoff value of infected cells in BAL fluid? Chest, 1996, 110: 1558-1565 .
|
| 10. |
Luyt CE, Combes A, Reynaud C, et al. Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med, 2008, 34: 1434-1440 .
|
- 1. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med, 2002, 165: 867-903.
- 2. American Thoracic Society, Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
- 3. Safdar N, Dezfuhan C, Collard HR. et al. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med, 2005, 33 : 2184 -2193.
- 4. Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a Meta-analysis. J Crit Care, 2008, 23 :91-100.
- 5. Luna CM, Aruj P, Niederman MS, et al. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur Respir J,2006, 27: 158-164 .
- 6. Rea-Neto A, Youssef NC, Tuche F, et al. Diagnosis of ventilatorassociated pneumonia: a systematic review of the literature. Crit Care, 2008, 12: R56.
- 7. Lisboa T, Rello J. Diagnosis of ventilator-associated pneumonia: is there a gold standard and a simple approach? Curt Opin Infect Dis, 2008, 21: 174-178 .
- 8. Wilke MH, Grube RF, Bodmann KF. The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients-a DRG-based simulation mode. Eur J Med Res, 2011, 16: 543-548 .
- 9. Allaouchiche B, Jaumain H, Dumontet C, et al. Early diagnosis of ventilator-associated pneumonia : is it possible to define a cutoff value of infected cells in BAL fluid? Chest, 1996, 110: 1558-1565 .
- 10. Luyt CE, Combes A, Reynaud C, et al. Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med, 2008, 34: 1434-1440 .
