Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-04-18

AUTHORS

Charles-Edouard Luyt, Alain Combes, Catherine Reynaud, Guillaume Hekimian, Ania Nieszkowska, Marc Tonnellier, Alexandra Aubry, Jean-Louis Trouillet, Maguy Bernard, Jean Chastre

ABSTRACT

ObjectiveTo assess the predictive capacity for the diagnosis of ventilator-associated pneumonia (VAP) of serum procalcitonin levels before and on the day it is suspected.Design and settingSingle-center observational study in the intensive care unit of a teaching hospital.Patients and participantsConsecutive patients whose serum procalcitonin levels were available on the day that VAP was clinically suspected (day 1) and at some time within the preceding 5 days (“before”).Measurements and resultsSerum procalcitonin levels were determined on day 1 and “before”. Among the 73 suspected episodes VAP was confirmed by quantitative bronchoalveolar lavage cultures in 32 and refuted in 41. Respective median “before” procalcitonin levels were 1.89 ng/ml (interquartile range 0.18–6.01) and 2.14 (0.76–5.75) in patients with and without VAP, but their respective median day-1 procalcitonin levels did not differ: 1.07 ng/ml (0.39–6.57) vs. 1.40 (0.67–3.39). On day 1 a 0.5 ng/ml procalcitonin threshold had 72% sensitivity but only 24% specificity for diagnosing VAP. Between “before” and day 1, procalcitonin increased in 41% and 15% of patients with and without VAP, respectively. Thus a procalcitonin rise on day 1, compared to its “before” level, had 41% sensitivity and 85% specificity for diagnosing VAP, with respective positive and negative predictive values of 68% and 65%.ConclusionsCrude values and procalcitonin rise had poor diagnostic value for VAP in this particular setting and thus should not be used to initiate antibiotics when VAP is clinically suspected. More... »

PAGES

1434-1440

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-008-1112-x

DOI

http://dx.doi.org/10.1007/s00134-008-1112-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1031025234

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/18421435


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25 schema:description ObjectiveTo assess the predictive capacity for the diagnosis of ventilator-associated pneumonia (VAP) of serum procalcitonin levels before and on the day it is suspected.Design and settingSingle-center observational study in the intensive care unit of a teaching hospital.Patients and participantsConsecutive patients whose serum procalcitonin levels were available on the day that VAP was clinically suspected (day 1) and at some time within the preceding 5 days (“before”).Measurements and resultsSerum procalcitonin levels were determined on day 1 and “before”. Among the 73 suspected episodes VAP was confirmed by quantitative bronchoalveolar lavage cultures in 32 and refuted in 41. Respective median “before” procalcitonin levels were 1.89 ng/ml (interquartile range 0.18–6.01) and 2.14 (0.76–5.75) in patients with and without VAP, but their respective median day-1 procalcitonin levels did not differ: 1.07 ng/ml (0.39–6.57) vs. 1.40 (0.67–3.39). On day 1 a 0.5 ng/ml procalcitonin threshold had 72% sensitivity but only 24% specificity for diagnosing VAP. Between “before” and day 1, procalcitonin increased in 41% and 15% of patients with and without VAP, respectively. Thus a procalcitonin rise on day 1, compared to its “before” level, had 41% sensitivity and 85% specificity for diagnosing VAP, with respective positive and negative predictive values of 68% and 65%.ConclusionsCrude values and procalcitonin rise had poor diagnostic value for VAP in this particular setting and thus should not be used to initiate antibiotics when VAP is clinically suspected.
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33 antibiotics
34 bronchoalveolar lavage culture
35 capacity
36 care unit
37 culture
38 day 1
39 days
40 design
41 diagnosis
42 diagnostic value
43 hospital
44 intensive care unit
45 lavage culture
46 levels
47 measurements
48 median
49 negative predictive value
50 observational study
51 particular setting
52 patients
53 pneumonia
54 poor diagnostic value
55 predictive capacity
56 predictive value
57 procalcitonin
58 procalcitonin levels
59 quantitative bronchoalveolar lavage cultures
60 respective medians
61 rise
62 sensitivity
63 serum procalcitonin levels
64 setting
65 specificity
66 study
67 teaching hospital
68 threshold
69 time
70 units
71 usefulness
72 usefulness of procalcitonin
73 values
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