Alveolar and Serum Procalcitonin

Duflo, Frédéric; Debon, Richard; Monneret, Guillaume; Bienvenu, Jacques; Chassard, D.; Allaouchiche, Bernard

doi:10.1097/00000542-200201000-00018

Cited by 125 publications

(28 citation statements)

References 2 publications

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“…In those patients with PCP the median values for BG in serum and BAL were 406 pg/mL and 500 pg/mL, respectively. When BG has been measured in BAL 17,18 the data appear to indicate that it does not add to the diagnostic accuracy of serum levels alone. Of note, both studies involved ventilator-associated pneumonia patients, not HIV patients with acute pulmonary infiltrates.…”

Section: Introductionmentioning

confidence: 91%

Serum and bal beta-d-glucan for the diagnosis of Pneumocystis pneumonia in HIV positive patients

Salerno

Mushatt

Myers

et al. 2014

Respiratory Medicine

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The diagnosis of patients with pulmonary infiltrates and human immunodeficiency virus (HIV) infection remains a challenge. In current clinical practice the gold standard for Pneumocystis jirovecii pneumonia (PCP) diagnosis remains the identification of the organism in broncoalveolar lavage (BAL) using microscopy (e.g., silver stain). (1->3)-β -D-glucan (BG) is a polysaccharide that is present within the cell wall of Pneumocystis and other fungi. We analyzed serum and BAL lavage fluid from a cohort of 119 patients that did have HIV, a diagnosis of pneumonia and underwent bronchoscopy (FOB) for diagnosis of PCP. The discriminative power of serum BG for the diagnosis of PCP in this group of patients was very high. Using a cutoff of 300 pg/mL, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 91%, 92%, 89% and 93% respectively. A model for ROC with just serum BG (N = 108) had an AUC of 0.95. Serum procalcitonin (PCT) and BAL BG were not as accurate for the diagnosis of PCP. For BAL BG using a cutoff of 783 pg/mL, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 72%, 79%, 72% and 79% respectively. The differences between the medians for serum PCT between the group with a without PCP did not reach statistical significance (p=0.6137). The measurement of serum BG should be incorporated in the diagnostic work up of HIV positive patients with dyspnea and infiltrates on chest X ray. Our study confirms the diagnostic value of serum BG previously reported by others but we add a cutoff value that we believe is more accurate for patients with AIDS and suspicion of PCP.

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Section: Introductionmentioning

confidence: 91%

Serum and bal beta-d-glucan for the diagnosis of Pneumocystis pneumonia in HIV positive patients

Salerno

Mushatt

Myers

et al. 2014

Respiratory Medicine

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“…PCT has been widely used for VAP diagnosis and follow-up in the adult population. However, the results provided by these studies have been very inconsistent, reporting great variability in the cutoff values and broad ranges of sensitivity and specificity [34,35,36], or even informing of a lack of association between PCT concentration and adequacy of therapy, etiology of VAP, or outcome [37]. …”

Section: Diagnostic Biomarkersmentioning

confidence: 99%

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

et al. 2013

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Ventilator-associated pneumonia (VAP) is a serious complication related to mechanical ventilation in the neonatal period. However, lack of a specific definition and difficulties obtaining noncontaminated samples of the lower respiratory airway render microbiological diagnosis and etiological treatment extremely difficult. Thus far, only few studies have approached VAP using accepted Centers for Disease Control and Prevention criteria and reliable sampling techniques. In recent years, however, the blind-protected bronchoalveolar lavage technique with protected specimen brush and the development of validated biomarkers have attempted to overcome the diagnostic difficulties and assess the response to therapy. This updated review on neonatal VAP aims to stimulate neonatologists' interest in this subtle but serious complication of mechanical ventilation.

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“…Concerning microbiological confirmation, obtaining cultures is time-consuming, cutoff values for colony-forming units are variable, and the effect of the previous antibiotic causes problems and delay in the diagnosis of VAP. Thus, there is a need for rapid, accurate, and inexpensive diagnostic and prognostic methods for VAP [17–19]. …”

Section: Discussionmentioning

confidence: 99%

“…CRP and PCT are used as parameters to monitor the clinical response in VAP [17, 18]. Recent VAP guidelines suggest that using PCT along with clinical criteria is required to monitor the treatment response and discontinue antibiotics [1].…”

Section: Discussionmentioning

confidence: 99%

Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

Bilgin

Haliloğlu

Yaman

et al. 2018

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Purpose The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p < 0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

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Alveolar and Serum Procalcitonin

Abstract: Serum but not alveolar procalcitonin seems to be a helpful parameter in the early VAP diagnosis and an appropriate marker for predicting mortality.

Cited by 125 publications

References 2 publications

Serum and bal beta-d-glucan for the diagnosis of Pneumocystis pneumonia in HIV positive patients

Serum and bal beta-d-glucan for the diagnosis of Pneumocystis pneumonia in HIV positive patients

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

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