The prognostic value of changes in the plasma cytokine profile of neuroresuscitation patients with ventilator-associated pneumonia: two center observational study

Abstract

Objectives. This study was performed to find changes in the plasma cytokine profile of neuroresuscitation patients with ventilator-associated pneumonia, and to search for prognostic markers of effectiveness of antibacterial treatment of ventilator-associated pneumonia. Materials and methods. A two-center clinical study, that included 73 patients aged 19 to 82 years with neurosurgical and neurological pathology and signs of ventilator-associated pneumonia (VAP) was conducted. On the 1st and 3rd days of antibiotic therapy, plasma samples were taken from patients, in which the concentration of 59 cytokines was determined. Retrospectively, patients were divided into groups of favorable and unfavorable clinical course of VAP. Predictors of the clinical course of the disease were identified using statistical methods, ROC analysis, and logistic regression. Results. Matrix metalloproteinase-2 (MMP-2) was the most sensitive predictor of the clinical outcomes of VAP in neuroresuscitation patients. In the group of patients with an unfavorable VAP, the concentration of MMP-2 in plasma was initially increased, but significantly decreased by the 3rd day, in contrast to the group with good outcomes. The logistic regression model predicted the clinical course of VAP with an accuracy of 69.2 %. Less sensitive but significant predictors of the clinical course of the disease were cytokines: interleukin-1 receptor antagonist, interleukin-6, granulocyte colony-stimulating factor, tumor necrosis factor superfamily member 14, osteocalcin, pentraxin, thymic stromal lymphopoietin, element 12 of the tumour necrosis factor ligand superfamily, and interleukin-12. Conclusions. Measurement of plasma cytokine levels is a prospective method to determine the effectiveness of antibacterial therapy in VAP. Matrix metalloproteinase-2 is a sensitive predictor of the clinical course of VAP in neurosurgical patients.