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

Pham, Dung Thai; Nguyen, Thach; Đỗ, Quyết

doi:10.4172/2161-1068.1000246

Cited by 2 publications

(4 citation statements)

References 10 publications

(11 reference statements)

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“…These findings suggest that combining cohorts based on HELICS and CPIS may be reasonable for meta-analysis or population studies, but the same may not be true for studies based on CDC/NHSN criteria as the diagnostic agreement is poor. Moreover, it is recommended that studies report serum procalcitonin values to better refine their data sets to optimize data utility as diagnostic algorithms evolve to best facilitate future meta-analyses and as procalcitonin may correlate with mortality [62]. Lastly, this data highlights how little progress these complicated VAP diagnostic algorithms have made beyond that of the historical and simple Johanson criteria.…”

Section: Discussionmentioning

confidence: 99%

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

et al. 2021

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Background Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. Methods A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient. Results Eighty-five patients were enrolled (VAP 45, controls 40). Using HELICS as the reference standard, the sensitivity and specificity for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%), CPIS (Sensitivity 68.75%; Specificity 95.23%), Johanson (Sensitivity 67.69%; Specificity 95%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level > 0.5 ng/ml was 51.8%. Conclusion VAP remains a considerable source of morbidity and mortality in modern intensive care units. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin > 0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin > 0.5 ng/ml, but not positive quantitative TAC. Trial Registration: Not indicated for this study type.

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Section: Discussionmentioning

confidence: 99%

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

et al. 2021

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“…These ndings suggest that combining cohorts based on HELICS and CPIS may be reasonable for meta-analysis or population studies, but the same may not be true for studies based on CDC/NHSN criteria as the diagnostic agreement is poor. Moreover, it is recommended that studies report serum procalcitonin values to better re ne their data sets to optimize data utility as diagnostic algorithms evolve to best facilitate future meta-analyses and as procalcitonin may correlate with mortality [82]. Lastly, this data highlights how little progress these complicated VAP diagnostic algorithms have made beyond that of the historical and simple Johanson criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Among the most studied biomarkers for VAP diagnosis and prognosis is serum procalcitonin. Serum procalcitonin concentration >0.5 ng/ml has been reported to have a diagnostic sensitivity and speci city of 68.25% and 89.83% respectively [67]. Others have reported that the optimal threshold value VAP diagnosis on day 1 was 5.0 ng/ml (sensitivity 91%, speci city 71%) [51].…”

Section: Discussionmentioning

confidence: 99%

“…Others have reported that the optimal threshold value VAP diagnosis on day 1 was 5.0 ng/ml (sensitivity 91%, speci city 71%) [51]. Furthermore, procalcitonin levels may correlate with mortality (75% at level >10 ng/ml) [67], however others have disputed its impact [7,8,68]. The current study found that serum procalcitonin concentration >0.5 ng/ml correlated moderately with a diagnosis of VAP by CPIS and Johanson criteria, but only slightly with CDC/NHSN criteria.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: A prospective observational study

Rahimi–Bashar

Miller

Yaghoobi

et al. 2021

Preprint

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BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 44, controls 41). Using HELICS as the reference standard, the respective true positive rate (TPR; sensitivity), true negative rate (TNR; specificity), false positive rate (FPR; fall-out) and false negative rate (FNR; miss-rate) for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%; FPR 95%; FNR 0%), CPIS (Sensitivity 68.75%; Specificity 95.23%; FPR 50%, FNR 2%), Johanson (Sensitivity 67.69%; Specificity 95%; FPR 52.5%, FNR 2%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level >0.5 ng/ml was 51.8%. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin >0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin >0.5 ng/ml, but not positive quantitative TAC.

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

Cited by 2 publications

References 10 publications

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: A prospective observational study

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