Prognostic Role of Clinical and Laboratory Criteria To Identify Early Ventilator-Associated Pneumonia in Brain Injury*

Pelosi, Paolo; Barassi, Alessandra; Severgnini, Paolo; Gomiero, Barbara; Finazzi, Sergio; Merlini, Giampaolo; d’Eril, Gianvico Melzi; Chiaranda, Maurizio; Niederman, Michael S.

doi:10.1378/chest.07-2546

Cited by 48 publications

(52 citation statements)

References 39 publications

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“…1). [18][19][20][21][22][23][24][25][26][27][28][29][30] All the studies identified were published between 1999 and 2010. The overall prevalence and mortality of VAP in the included studies were 48% and 37%, respectively.…”

Section: Study Selectionmentioning

confidence: 99%

“…Figure 3C shows the forest plot of the diagnostic odds ratio. Twelve of the 13 studies are plotted as the confidence intervals of the odds ratio; the 2008 study by Pelosi et al 19 had an infinite odds ratio value. Figure 3D shows the summary receiver operating characteristic curve.…”

Section: Diagnostic Accuracy Of Cpis For Diagnosis Of Vapmentioning

confidence: 99%

“…[19][20]22,[24][25][26][27][28][29][30] Moreover, the calculation of CPIS was modified by some authors, and different cutoff points were used to diagnose VAP. Importantly, the inter-observer variability affected the sensitivity and specificity.…”

Section: Limitationsmentioning

confidence: 99%

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Diagnostic Accuracy of Clinical Pulmonary Infection Score for Ventilator-Associated Pneumonia: A Meta-analysis

2011

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OBJECTIVE: To assess the diagnostic accuracy of the clinical pulmonary infection score in the diagnosis of ventilator-associated pneumonia in mechanically ventilated patients. METHODS: We searched PubMed and the Cochrane database, and included only studies that compared clinical pulmonary infection score with quantitative microbiological analysis of samples for diagnosing ventilator-associated pneumonia. We constructed 2-by-2 tables of diagnostic accuracy from each article, and meta-analyzed the results by pooling estimates of sensitivity, specificity, likelihood ratio for positive index test, likelihood ratio for negative index test, diagnostic odds ratio, and 95% confidence intervals. RESULTS: Thirteen studies met the inclusion criteria. The pooled estimates for sensitivity and specificity for clinical pulmonary infection score were 65% (95% CI 61-69%) and 64% (95% CI 60 -67%), respectively. The combined diagnostic odds ratio was 4.85 (95% CI 2.42-9.71) and the area under the curve was 0.748 (95% CI 0.65-0.85). CONCLUSIONS: The diagnostic performance of the clinical pulmonary infection score for ventilator-associated pneumonia is moderate. However, the clinical pulmonary infection score is simple and easy to perform, and may still be useful in diagnosing ventilator-associated pneumonia.

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Section: Study Selectionmentioning

confidence: 99%

Section: Diagnostic Accuracy Of Cpis For Diagnosis Of Vapmentioning

confidence: 99%

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Diagnostic Accuracy of Clinical Pulmonary Infection Score for Ventilator-Associated Pneumonia: A Meta-analysis

2011

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“…Procalcitonin may be considered as a valuable biomarker for the diagnosis of bacterial infections, including VAP, where its levels are correlated with outcome [25,26]. Its usefulness for guiding antibiotic therapy has been shown in patients admitted for community-acquired respiratory tract infections [27][28][29].…”

mentioning

confidence: 99%

Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study

Stolz¹,

Smyrnios²,

Eggimann³

et al. 2009

European Respiratory Journal

278

267

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In patients with ventilator-associated pneumonia (VAP), guidelines recommend antibiotic therapy adjustment according to microbiology results after 72 h. Circulating procalcitonin levels may provide evidence that facilitates the reduction of antibiotic therapy.In a multicentre, randomised, controlled trial, 101 patients with VAP were assigned to an antibiotic discontinuation strategy according to guidelines (control group) or to serum procalcitonin concentrations (procalcitonin group) with an antibiotic regimen selected by the treating physician. The primary end-point was antibiotic-free days alive assessed 28 days after VAP onset and analysed on an intent-to-treat basis.Procalcitonin determination significantly increased the number of antibiotic free-days alive 28 days after VAP onset (13 (2-21) days versus 9.5 (1.5-17) days). This translated into a reduction in the overall duration of antibiotic therapy of 27% in the procalcitonin group (p50.038). After adjustment for age, microbiology and centre effect, the rate of antibiotic discontinuation on day 28 remained higher in the procalcitonin group compared with patients treated according to guidelines (hazard rate 1.6, 95% CI 1.02-2.71). The number of mechanical ventilation-free days alive, intensive care unit-free days alive, length of hospital stay and mortality rate on day 28 for the two groups were similar.Serum procalcitonin reduces antibiotic therapy exposure in patients with ventilator associated pneumonia.

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“…Procalcitonin increased the specificity of clinical pulmonary infection score to 100%. The author concluded that procalcitonin may be a useful marker to predict which patients subsequently have early ventilator-associated pneumonia [11]. Ramirez P et al made sequential measurement of serum procalcitonin level and the calculation of the simplified clinical pulmonary infection score in 44 patients mechanically ventilated for >48 hours with neither active infection for the duration or suspicion of ventilator-associated pneumonia.…”

Section: Discussionmentioning

confidence: 99%

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

Pham¹,

Nguyen²,

Đỗ³

2017

Mycobact Dis

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Prognostic Role of Clinical and Laboratory Criteria To Identify Early Ventilator-Associated Pneumonia in Brain Injury*

Abstract: PCT may be a useful marker to predict which patients subsequently have early VAP. The CPIS could help as an early way to detect the patients with early VAP and who need further diagnostic testing.

Cited by 48 publications

References 39 publications

Diagnostic Accuracy of Clinical Pulmonary Infection Score for Ventilator-Associated Pneumonia: A Meta-analysis

Diagnostic Accuracy of Clinical Pulmonary Infection Score for Ventilator-Associated Pneumonia: A Meta-analysis

Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study

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

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