The clinical value of procalcitonin detection in diagnosis and treatment of ventilator associated pneumonia / 中国基层医药

ABSTRACT

Objective To assess the value of procalcitonin(PCT) in diagnosis and treatment of ventilator associated pneumonia(VAP). Methods 60 patients on ventilators were divided into VAP group and non-VAP group depending on whether the patients developed VAP in 7 days or not. The VAP group again was divided into PCT group and the control group. Data of PCT, C-reactive protein (CRP) and WBC were assessed at baseline, in 6 hours when VAP was suspected, and every two days after mechanical ventilation. The control group received antibiotics according to usual practice and stopped when CPIS≤6 scores. Antibiotic treatment of the PCT group was based on serum PCT concentrations. Results The CRP and WBC showed no obvious difference between the VAP and non-VAP group before mechanical ventilation ( all P ＞ 0. 05 ), after ventilation both mean values increased, with the P 0. 046 and 0. 822,respectively;Taking CRP≥28mg/L and WBC≥ 10×109/L as the cutoff value,the diagnostic sensitivity of CRP and WBC for VAP were 73.3% and 66.7% respectively,their specificity was 50% and 43.3 % ,respectively.Taking PCT ≥0.40μg/L as the cutoff value, the PCT positive percentage did not show difference between VAP group and non-VAP group before mechanical ventilation( P ＞ 0. 05 ). However, it was much higher in the VAP group than that of non-VAP group after mechanical ventilation( P ＜ 0. 01 ). The PCT level of 0.40 ug/l yielded a 93.3% sensitivity and a 73.3 % specificity for VAP in the study cohort ( AUROCC = 0. 823; 95 % CI,0.71-0. 94; P ＜ 0. 01 ). The antibiotic duration of the PCT group was( 12. 6 ± 5.6) days compared with( 15. 1 ± 9.1 ) days for the control group (P ＜ 0. 05). Patients assigned to the PCT group had 2.5 days shorter mean duration of antibiotic therapy for the first episode of infection than the control group ( P ＜ 0. 05 ). Conclusion PCT had high sensitivity in the diagnosis of VAP. CPIS ≥6 combined with serum levels of PCT ≥0. 40μg/L markedly improved the specificity( 100% ). PCT guidance substantially reduced antibiotic use in VAP, so that timely surveillance of serum PCT was necessary for patients on ventilator.