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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2016

Open Access 01-12-2016 | Research

Biomarker kinetics in the prediction of VAP diagnosis: results from the BioVAP study

Authors: Pedro Póvoa, Ignacio Martin-Loeches, Paula Ramirez, Lieuwe D. Bos, Mariano Esperatti, Joana Silvestre, Gisela Gili, Gema Goma, Eugenio Berlanga, Mateu Espasa, Elsa Gonçalves, Antoni Torres, Antonio Artigas

Published in: Annals of Intensive Care | Issue 1/2016

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Abstract

Background

Prediction of diagnosis of ventilator-associated pneumonia (VAP) remains difficult. Our aim was to assess the value of biomarker kinetics in VAP prediction.

Methods

We performed a prospective, multicenter, observational study to evaluate predictive accuracy of biomarker kinetics, namely C-reactive protein (CRP), procalcitonin (PCT), mid-region fragment of pro-adrenomedullin (MR-proADM), for VAP management in 211 patients receiving mechanical ventilation for >72 h. For the present analysis, we assessed all (N = 138) mechanically ventilated patients without an infection at admission. The kinetics of each variable, from day 1 to day 6 of mechanical ventilation, was assessed with each variable’s slopes (rate of biomarker change per day), highest level and maximum amplitude of variation (Δ max).

Results

A total of 35 patients (25.4 %) developed a VAP and were compared with 70 non-infected controls (50.7 %). We excluded 33 patients (23.9 %) who developed a non-VAP nosocomial infection. Among the studied biomarkers, CRP and CRP ratio showed the best performance in VAP prediction. The slope of CRP change over time (adjusted odds ratio [aOR] 1.624, confidence interval [CI]95% [1.206, 2.189], p = 0.001), the highest CRP ratio concentration (aOR 1.202, CI95% [1.061, 1.363], p = 0.004) and Δ max CRP (aOR 1.139, CI95% [1.039, 1.248], p = 0.006), during the first 6 days of mechanical ventilation, were all significantly associated with VAP development. Both PCT and MR-proADM showed a poor predictive performance as well as temperature and white cell count.

Conclusions

Our results suggest that in patients under mechanical ventilation, daily CRP monitoring was useful in VAP prediction.
Trial registration NCT02078999
Appendix
Available only for authorised users
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Metadata
Title
Biomarker kinetics in the prediction of VAP diagnosis: results from the BioVAP study
Authors
Pedro Póvoa
Ignacio Martin-Loeches
Paula Ramirez
Lieuwe D. Bos
Mariano Esperatti
Joana Silvestre
Gisela Gili
Gema Goma
Eugenio Berlanga
Mateu Espasa
Elsa Gonçalves
Antoni Torres
Antonio Artigas
Publication date
01-12-2016
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2016
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-016-0134-8

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