Diagnosis of Ventilator-Associated Pneumonia
| Autor: | Anna Caldini, Adriano Peris, Morena Cozzolino, Tiziana Biagioli, Alessandro Terreni, Giovanni Zagli |
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| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Receiver operating characteristic business.industry Ventilator-associated pneumonia Retrospective cohort study Emergency department bacterial infections and mycoses Critical Care and Intensive Care Medicine medicine.disease Intensive care unit Procalcitonin respiratory tract diseases Surgery law.invention Pneumonia law Predictive value of tests Internal medicine medicine Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 146:1578-1585 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.13-2922 |
| Popis: | BACKGROUND:To facilitate the clinical diagnosis of ventilator-associated pneumonia (VAP) in the ICU, the Clinical Pulmonary Infection Score (CPIS) has been proposed but has shown a low diagnostic performance in subsequent studies. We propose a new score based on procalcitonin level and chest echography with the aim of improving VAP diagnosis: the Chest Echography and Procalcitonin Pulmonary Infection Score (CEPPIS). METHODS:This retrospective pilot study recruited patients admitted to the Intensive Care Unit of the Emergency Department, Careggi University Hospital (Florence, Italy), from January 2009 to December 2011. Patients were retrospectively divided into a microbiologically confirmed VAP group or a control group based on diagnosis of VAP and positive tracheal aspirate culture. RESULTS:A total of 221 patients were included, with 113 in the microbiologically confirmed VAP group and 108 in the control group. A CEPPIS > 5 retrospectively fixed was significantly better in predicting VAP (OR, 23.78; sensitivity, 80.5%; specificity, 85.2%) than a CPIS > 6 (OR, 3.309; sensitivity, 39.8%; specificity, 83.3%). The receiver operating characteristic area under the curve analysis also showed a significantly higher diagnostic value for CEPPIS > 5 than CPIS > 6 (0.829 vs 0.616, respectively;P< .0001). CONCLUSIONS:In this pilot, exploratory analysis, CEPPIS is effective in predicting VAP. Prospective validation is needed to confirm the potential value of this score to facilitate VAP diagnosis. |
| Databáze: | OpenAIRE |
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