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Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography.
Chest. 2014 Aug 21;
Authors: Zagli G, Cozzolino M, Terreni A, Biagioli T, Caldini AL, Peris A
Abstract
Abstract: BackgroundTo facilitate the clinical diagnosis of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU), the clinical pulmonary infection score (CPIS) has been proposed, which, however, has shown a low diagnostic performance in subsequent studies. Here we propose a new score based on procalcitonin and chest echography with the aim of improving VAP diagnosis: the CEPPIS (Chest Echography and Procalcitonin Pulmonary Infection Score). MethodsThis is a retrospective pilot study in which patients admitted to the ICU of the Emergency Department (Careggi University Hospital, Florence, Italy) from Jan 2009 to Dec 2011 were considered. Patients were retrospectively divided into a microbiologically-confirmed VAP group or a control group, based on diagnosis of VAP and positivity of tracheal aspirate culture. ResultsA total of 221 patients were included, 113 in the microbiologically-confirmed VAP group and 108 in the control group. A CEPPIS score of >5 retrospectively fixed resulted to be significantly better in predicting VAP (OR 23.78, sensitivity 80.5%, specificity 85.2%) than CPIS >6 (OR 3.309, sensitivity 39.8%, specificity 83.3%). The AUC-ROC analysis also showed a significantly higher diagnostic value for CEPPIS >5 than CPIS >6 (AUC 0.829 vs 0.616, respectively; P < 0.0001). ConclusionsIn our pilot, exploratory analysis, CEPPIS had an acceptable and promising level of prediction effectiveness in VAP diagnosis. Prospective validation is needed to confirm the potential value of this score to facilitate VAP diagnosis.
Background: To facilitate the clinical diagnosis of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU), the clinical pulmonary infection score (CPIS) has been proposed, which, however, has shown a low diagnostic performance in subsequent studies. Here we propose a new score based on procalcitonin and chest echography with the aim of improving VAP diagnosis: the CEPPIS (Chest Echography and Procalcitonin Pulmonary Infection Score).
Methods: This is a retrospective pilot study in which patients admitted to the ICU of the Emergency Department (Careggi University Hospital, Florence, Italy) from Jan 2009 to Dec 2011 were considered. Patients were retrospectively divided into a microbiologically-confirmed VAP group or a control group, based on diagnosis of VAP and positivity of tracheal aspirate culture.
Results: A total of 221 patients were included, 113 in the microbiologically-confirmed VAP group and 108 in the control group. A CEPPIS score of >5 retrospectively fixed resulted to be significantly better in predicting VAP (OR 23.78, sensitivity 80.5%, specificity 85.2%) than CPIS >6 (OR 3.309, sensitivity 39.8%, specificity 83.3%). The AUC-ROC analysis also showed a significantly higher diagnostic value for CEPPIS >5 than CPIS >6 (AUC 0.829 vs 0.616, respectively; P < 0.0001).
Conclusions: In our pilot, exploratory analysis, CEPPIS had an acceptable and promising level of prediction effectiveness in VAP diagnosis. Prospective validation is needed to confirm the potential value of this score to facilitate VAP diagnosis.
PMID: 25144666 [PubMed - as supplied by publisher]