Combined Estimation of Serum Procalcitonin Levels and Clinical Pulmonary Infection Score Improves Predictability for Survival of Ventilation-associated Pneumonia Patients

Al-kholy, Adel A.; Salem, Ahmed E.; Hagras, Maha M.

doi:10.21608/besps.2017.8243

Combined Estimation of Serum Procalcitonin Levels and Clinical Pulmonary Infection Score Improves Predictability for Survival of Ventilation-associated Pneumonia Patients

Document Type : Original Article

Authors

¹ Department of Medical Biochemistry, Faculty of Medicine, Benha University, Egypt.

² Department of Anesthesia & ICU, Faculty of Medicine, Tanta University, Egypt.

³ Department of Clinical Pathology, Faculty of Medicine, Tanta University, Egypt.

10.21608/besps.2017.8243

Abstract

Objectives: To evaluate predictability of estimation of C-reactive protein (CRP) and procalcitonin (PCT) levels for diagnosis and survival of ventilator-associated pneumonia (VAP) patients. Patients & Methods: The study included 53 VAP patients and 37 No VAP patients who were assessed using Clinical Pulmonary Infection Score (CPIS) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Blood samples were collected on D0 and D4 for estimation of serum CRP and PCT levels. Patients were managed according to Surviving Sepsis Campaign guidelines. The 28-day mortality rate (MR) and the predictors for mortality were determined. Results: Total MR was 43.3% with significant difference between both groups. APACHE II and CPIS scores were significantly higher in non-survivors of both groups and in VAP than No VAP patients. Serum CRP and PCT levels were significantly higher in VAP patients and in non-survivors than survivors. Change of CRP level was significantly higher in No VAP than VAP survivors, while change of PCT levels was significantly higher in VAP survivors than non-survivors. High CPIS score and D0 PCT level, but low decreases of CRP and PCT levels are positive predictors for VAP diagnosis. High D4 PCT level and CPIS scores, but low decreases of PCT levels are significant predictors for mortality. Conclusion: VAP had high 28-day mortality rate. Combined evaluation of CPIS score and PCT levels improved the ability to diagnose VAP and low levels of both are independent predictors of survival.

Keywords