Biomarker kinetics in the prediction of VAP diagnosis: results from the BioVAP study

Abstract

Background Prediction of diagnosis of ventilator-associated pneumonia (VAP) remains difficult. Our aim was to assess the value of biomarker kinetics in VAP prediction.MethodsWe performed a prospective, multicenter, observational study to evaluate predictive accuracy of biomarker kinetics, namely C-reactive protein (CRP), procalcitonin (PCT), mid-region fragment of pro-adrenomedullin (MR-proADM), for VAP management in 211 patients receiving mechanical ventilation for >72 h. For the present analysis, we assessed all (N = 138) mechanically ventilated patients without an infection at admission. The kinetics of each variable, from day 1 to day 6 of mechanical ventilation, was assessed with each variable’s slopes (rate of biomarker change per day), highest level and maximum amplitude of variation (Δmax).ResultsA total of 35 patients (25.4 %) developed a VAP and were compared with 70 non-infected controls (50.7 %). We excluded 33 patients (23.9 %) who developed a non-VAP nosocomial infection. Among the studied biomarkers, CRP and CRP ratio showed the best performance in VAP prediction. The slope of CRP change over time (adjusted odds ratio [aOR] 1.624, confidence interval [CI]95% [1.206, 2.189], p = 0.001), the highest CRP ratio concentration (aOR 1.202, CI95% [1.061, 1.363], p = 0.004) and Δmax CRP (aOR 1.139, CI95% [1.039, 1.248], p = 0.006), during the first 6 days of mechanical ventilation, were all significantly associated with VAP development. Both PCT and MR-proADM showed a poor predictive performance as well as temperature and white cell count.ConclusionsOur results suggest that in patients under mechanical ventilation, daily CRP monitoring was useful in VAP prediction.Trial registration NCT02078999Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0134-8) contains supplementary material, which is available to authorized users.

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

“…This is a post hoc analysis of tracheal aspirates of patients who were originally included in an international multicentre prospective observational cohort study of the predictive value of biological markers for development of VAP 14. The study protocol was reviewed and approved by the Medical Ethical Committee of Parc Tauli, Sabadell, Spain (IRB: 2008/524).…”

Ventilator-associated pneumonia in adults: a narrative review

“…Biomarkers such as C-reactive protein, procalcitonin or soluble triggering receptor expressed on myeloid cells (sTREM-1) have been proposed as diagnostic markers for VAP; however, they lack accuracy and their use is, to date, not recommended for VAP diagnosis [34,65,[72][73][74][75].…”

Appraisal of systemic inflammation and diagnostic markers in a porcine model of VAP: secondary analysis from a study on novel preventive strategies

“…All inflammatory markers data are reported as log pg/L. Aforementioned biomarkers were chosen based on previous clinical studies assessing systemic and pulmonary inflammation during pneumonia [ 10 , 11 , 23 – 27 ].…”

“…Inflammatory biomarkers in blood or bronchoalveolar lavage fluids of patients with VAP [ 9 – 11 ] not only have been tested to characterize inflammation but also to accurately and promptly diagnose VAP. Indeed, VAP is currently diagnosed using clinical criteria and microbiology cultures, which yield low specificity/sensitivity and are often too slow for clinical needs [ 12 ].…”