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Serum Procalcitonin as A Good Marker for Diagnosis and Prognosis of Ventilator Associated Pneumonia
Abstract
Objective: The purpose of this study was to investigate the value of serum level of procalcitonin as diagnostic and prognostic marker during ventilator pneumonia.
Methods: 92 patients with a strong suspicion of VAP were enrolled in this study. The diagnosis of VAP depends on the clinical criteria of pulmonary infection and presence of radiological findings. APACHE II was calculated during the first 24 hours of admission to ICU. Chest X-ray, arterial blood gases, complete blood count, creatinine, total bilirubin, albumin, PCT and CRP were obtained by the time VAP was suspected (D1) and repeated on the third day of treatment (D3) and on the seventh day (D7). PCT was determined with the commercially available ELISA assay (Uscn Life Science Inc. Wuhan) with an analytical sensitivity of 7 pg/ml and analyzed with BA-88A, MINDRAY. Semi-automated chemistry analyzer. CRP was measured by ELISA assay.
Results: Serum PCT above10 pg/ml was considered a highly positive for diagnosis of VAP. The serum procalcitonin in non VAP did not exceed 7.7pg/ml. It was significantly higher at (D1) in VAP group (49.77± 36.22 pg/ml) than non VAP (5.8±2.28 pg/ml). Also the PCT was significantly higher in patients with bad outcome than those with good outcome at day 1. The level of PCT decreased significantly from day 1 to day 3 and 7 in response to the medical management; however it was still higher in patients with bad outcome. As regards the microorganisms considered responsible for VAP group the percentage of Pseudomonas aeruginosa infections was higher in patients with bad outcome. The CRP was significantly higher in VAP patients than non VAP and there was a positive correlation with the increase level of PCT (r=0.86).
Conclusion: Serum PCT seems to be a good marker for early diagnosis of VAP before establishment of the microorganism results and the level of PCT may help in determination of the outcome.
Methods: 92 patients with a strong suspicion of VAP were enrolled in this study. The diagnosis of VAP depends on the clinical criteria of pulmonary infection and presence of radiological findings. APACHE II was calculated during the first 24 hours of admission to ICU. Chest X-ray, arterial blood gases, complete blood count, creatinine, total bilirubin, albumin, PCT and CRP were obtained by the time VAP was suspected (D1) and repeated on the third day of treatment (D3) and on the seventh day (D7). PCT was determined with the commercially available ELISA assay (Uscn Life Science Inc. Wuhan) with an analytical sensitivity of 7 pg/ml and analyzed with BA-88A, MINDRAY. Semi-automated chemistry analyzer. CRP was measured by ELISA assay.
Results: Serum PCT above10 pg/ml was considered a highly positive for diagnosis of VAP. The serum procalcitonin in non VAP did not exceed 7.7pg/ml. It was significantly higher at (D1) in VAP group (49.77± 36.22 pg/ml) than non VAP (5.8±2.28 pg/ml). Also the PCT was significantly higher in patients with bad outcome than those with good outcome at day 1. The level of PCT decreased significantly from day 1 to day 3 and 7 in response to the medical management; however it was still higher in patients with bad outcome. As regards the microorganisms considered responsible for VAP group the percentage of Pseudomonas aeruginosa infections was higher in patients with bad outcome. The CRP was significantly higher in VAP patients than non VAP and there was a positive correlation with the increase level of PCT (r=0.86).
Conclusion: Serum PCT seems to be a good marker for early diagnosis of VAP before establishment of the microorganism results and the level of PCT may help in determination of the outcome.
