Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia.

Autores de IIS La Fe

• Paula Ramírez Galleymore

  Autor

• María Pilar Ferrer Hernandez

  Autor

• Justo Aznar Lucea

  Autor

• José Miguel Sahuquillo Arce

  Autor

• Rosario Menéndez Villanueva

  Autor

• Javier Vijande Asenjo

  Autor

• Antonio Torres Marti

  Autor

Participantes ajenos a IIS La Fe

• Garcia MA
• Valencia M

Grupos

• Infecciones Respiratorias

Abstract

The utility of procalcitonin levels to improve the accuracy of clinical and microbiological parameters in diagnosing ventilator-associated pneumonia (VAP) was evaluated. Sequential measurement of procalcitonin and C-reactive protein levels and the calculation of the simplified Clinical Pulmonary Infection Scores (CPIS) were performed in 44 patients mechanically-ventilated for >48 h with neither active infection for the duration or suspicion of VAP. Patients who developed extrapulmonary infection were excluded. In total, 20 cases were suspected of having VAP and diagnosis was microbiologically confirmed in nine. In patients with confirmed VAP, procalcitonin levels were higher than in those without VAP. C-reactive protein levels and CPIS were lower in patients without suspected VAP, but could not discriminate confirmed and nonconfirmed suspicion of VAP. The best sensitivity and specificity (78 and 97%, respectively) corresponded to procalcitonin. The CPIS resulted in the same sensitivity, but had a lower specificity (80%). C-reactive protein had the worst sensitivity (56%), but a good specificity (91%). A CPIS >or=6 combined with serum levels of procalcitonin >or=2.99 ng.mL(-1) did not improve the sensitivity (67%), but resulted in 100% specificity. Procalcitonin might be useful in the diagnosis of ventilator-associated pneumonia. Combined values of Clinical Pulmonary Infection Scores and procalcitonin below the cut-off points excluded false-positive diagnoses of ventilator-associated pneumonia.