Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability

Schurink, Carolina A. M.; Nieuwenhoven, Christianne A. van; Jacobs, Jan; Rozenberg-Arska, M.; Joore, Hans C. A.; Buskens, Erik; Hoepelman, Andy I. M.; Bonten, Marc J. M.

doi:10.1007/s00134-003-2018-2

Cited by 210 publications

(132 citation statements)

References 22 publications

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“…In contrast, absolute procalcitonin failed to predict clinical efficacy due to the fact that it was affected by various factors, including concurrent infection at other sites, severity of infection, trauma, and surgery. 33 Similarly, use of mCPIS is also not suitable for patients with trauma, surgery, or ARDS, 34,35 but better predictive ability was observed when combined with procalcitonin kinetics.…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

Shi

Xu²,

Rui

et al. 2013

Respir Care

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BACKGROUND: Early identification of treatment failure for nosocomial pneumonia remains a major challenge. The goal of this study was to test whether procalcitonin kinetics can be used to assess the clinical efficacy in older critically ill patients with nosocomial pneumonia. METHODS: A prospective observational study was conducted with 60 subjects (> 65 y old) admitted to the ICU with severe nosocomial pneumonia. Serum procalcitonin was measured on days 0, 3, and 7 and at the end of treatment. The procalcitonin time course was analyzed according to the therapeutic efficacy. RESULTS: Procalcitonin levels were elevated in all subjects (n ‫؍‬ 60) on day 0, and the median level (range) was 2.5 (0.85-42.7) g/L. There were no differences in procalcitonin between the improved subjects (n ‫؍‬ 41) and those without improvement (n ‫؍‬ 19) on day 0 (P > .05). However, lower procalcitonin levels on days 3 and 7 and at the end of treatment (all P < .05) and greater rates of procalcitonin decline between days 0 and 3 (⌬PCT d3 %; 29.5 ؎ 10.8% vs 15.1 ؎ 5.9%, P ‫؍‬ .009) were observed in the improved subjects compared with those with no improvement. ⌬PCT d3 % was the best single predictor of efficacy (area under the curve of 0.79, P < .001) and had a sensitivity of 75.7% and a specificity of 72.0% with a threshold of 26.2%. By comparison, traditional parameters and absolute procalcitonin failed to predict treatment response (P > .05). Indeed, the combination of ⌬PCT d3 % > 26.2% and a modified Clinical Pulmonary Infection Score of < 6 points improved the predictive value (area under the curve of 0.89, sensitivity of 81.3%, specificity of 86.5%). CONCLUSIONS: Procalcitonin levels were not influenced by aging, and procalcitonin kinetics might help to identify treatment failure. ⌬PCT d3 % in combination with the Clinical Pulmonary Infection Score has been shown to be a marker of clinical efficacy at an earlier stage.

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Section: Discussionmentioning

confidence: 99%

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

Shi

Xu²,

Rui

et al. 2013

Respir Care

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“…The high sensitivity of the pepsin assay might also be perceived as a limitation since it detected aspiration in 88.9% of the patients; however, as described above, the assay's sensitivity ceased to be a problem when a distinction was made between frequent and infrequent aspirators. A limitation of the study was use of the CPIS to diagnose pneumonia (30). Despite good agreement between CPIS scores and bronchoalveolar lavage findings for the 32 patients who had the latter procedure performed, it is probable that the CPIS overestimated pneumonia.…”

Section: Strengths and Limitationsmentioning

confidence: 94%

Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors

Metheny

Clouse

Chang

et al. 2006

Critical Care Medicine

325

240

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Objectives-To describe the frequency of pepsin-positive tracheal secretions (a proxy for the aspiration of gastric contents), outcomes associated with aspiration (including a positive Clinical Pulmonary Infection Score [a proxy for pneumonia] and use of hospital resources), and risk factors associated with aspiration and pneumonia in a population of critically ill tube-fed patients.Design-Prospective descriptive study conducted over a 2-yr period. Setting-Five intensive care units in a university-affiliated medical center with level I trauma status.Patients-Each of the 360 adult patients participated for 4 days. Among the inclusion criteria were mechanical ventilation and tube feedings. An exclusion criterion was physician-diagnosed pneumonia at the time of enrollment. Intervention-None.Measurements and Major Results-Almost 6,000 tracheal secretions collected during routine suctioning were assayed for pepsin; of these, 31.3% were positive. At least one aspiration event was identified in 88.9% (n = 320) of the participants. The incidence of pneumonia (as determined by the Clinical Pulmonary Infection Score) increased from 24% on day 1 to 48% on day 4. Patients with pneumonia on day 4 had a significantly higher percentage of pepsin-positive tracheal secretions than did those without pneumonia (42.2% vs. 21.1%, respectively; p < .001). Length of stay in the intensive care unit and need for ventilator support were significantly greater for patients with pneumonia (p < .01). A low backrest elevation was a risk factor for aspiration (p = .024) and pneumonia (p = .018). Other risk factors for aspiration included vomiting (p = .007), gastric feedings (p = .009), a Glasgow Coma Scale score <9 (p = .021), and gastroesophageal reflux disease (p = .033). The most significant independent risk factors for pneumonia were aspiration (p < .001), use of paralytic agents (p = .002), and a high sedation level (p = .039).Conclusions-Aspiration of gastric contents is common in critically ill tube-fed patients and is a major risk factor for pneumonia. Furthermore, it leads to greater use of hospital resources. Modifiable risk factors for aspiration need to be addressed. Keywords critical illness; enteral nutrition; aspiration pneumonia; risk factors; gastroesophageal reflux; gastric emptyingThe authors have no financial interests to disclose.The study was performed at Saint Louis University Hospital, in St. Louis, MO. NIH Public Access Author ManuscriptCrit Care Med. Author manuscript; available in PMC 2008 May 23. Published in final edited form as:Crit Care Med. 2006 April ; 34(4): 1007-1015. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptTracheobronchial aspiration can be defined as the inhalation of oropharyngeal or gastric contents into the respiratory tract (1). Although aspiration from either source is important, the type of greatest concern in critically ill tube-fed patients is tracheobronchial aspiration of gastric contents. The extent to which aspiration of gastric contents occurs is difficu...

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“…The study variables included age, sex, Clinical Pulmonary Infection Score (CPIS) as described by Pugin et al [4], clinical pulmonary infection score as described by Schurink et al [5], VAP treatment outcomes, serum procalcitonin level.…”

Section: Methodsmentioning

confidence: 99%

Researching the Changes of Serum Procalcitonin Levels in Ventilator-Associated Pneumonia Patients

Pham¹,

Nguyen²,

Đỗ³

2017

Mycobact Dis

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Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability

Abstract: When compared to quantitative cultures of bronchoalveolar lavage fluid, the CPIS has a low sensitivity and specificity for diagnosing ventilator-associated pneumonia with considerable inter-observer variability.

Cited by 210 publications

References 22 publications

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors

Researching the Changes of Serum Procalcitonin Levels in Ventilator-Associated Pneumonia Patients

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