ABSTRACT
INTRODUCTION: This study sought to assess the prognostic value of the kinetics of procalcitonin (PCT), C-reactive protein (CRP) and clinical scores (clinical pulmonary infection score (CPIS), Sequential Organ Failure Assessment (SOFA)) in the outcome of ventilator-associated pneumonia (VAP) at an early time point, when adequacy of antimicrobial treatment is evaluated. METHODS: This prospective observational cohort study was conducted in a teaching hospital. The subjects were 75 patients consecutively admitted to the intensive care unit from October 2003 to August 2005 who developed VAP. Patients were followed for 28 days after the diagnosis, when they were considered survivors. Patients who died before the 28th day were non-survivors. There were no interventions. RESULTS: PCT, CRP and SOFA score were determined on day 0 and day 4. Variables included in the univariable logistic regression model for survival were age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, decreasing DeltaSOFA, decreasing DeltaPCT and decreasing DeltaCRP. Survival was directly related to decreasing DeltaPCT with odds ratio (OR) = 5.67 (95% confidence interval 1.78 to 18.03), decreasing DeltaCRP with OR = 3.78 (1.24 to 11.50), decreasing DeltaSOFA with OR = 3.08 (1.02 to 9.26) and APACHE II score with OR = 0.92 (0.86 to 0.99). In a multivariable logistic regression model for survival, only decreasing DeltaPCT with OR = 4.43 (1.08 to 18.18) and decreasing DeltaCRP with OR = 7.40 (1.58 to 34.73) remained significant. Decreasing DeltaCPIS was not related to survival (p = 0.59). There was a trend to correlate adequacy to survival. Fifty percent of the 20 patients treated with inadequate antibiotics and 65.5% of the 55 patients on adequate antibiotics survived (p = 0.29). CONCLUSION: Measurement of PCT and CRP at onset and on the fourth day of treatment can predict survival of VAP patients. A decrease in either one of these marker values predicts survival.
Subject(s)
C-Reactive Protein/antagonists & inhibitors , Calcitonin/antagonists & inhibitors , Pneumonia, Bacterial/blood , Pneumonia, Bacterial/mortality , Protein Precursors/antagonists & inhibitors , Ventilators, Mechanical/microbiology , Adult , Aged , Aged, 80 and over , C-Reactive Protein/biosynthesis , Calcitonin/biosynthesis , Calcitonin/blood , Calcitonin Gene-Related Peptide , Cohort Studies , Humans , Middle Aged , Prospective Studies , Protein Precursors/biosynthesis , Protein Precursors/blood , Respiration, Artificial/mortality , Survival RateABSTRACT
O objetivo deste artigo é relacionar o uso de cateteres com a ocorrência de bacteremia e sepse. A cultura foi considerada positiva quando houve crescimento de 15 ou mais colônias em placa. A identificação bacteriana foi realizada através de provas bioquímicas ou através do sistema MicroScan (Dade Behring). As hemoculturas foram incubadas e monitoradas pelo sistema Bact Alert (Organon teknika). Do total de 79 cateteres, 30,3% tiveram uma cultura positiva (24/79). Em 11,4% dos casos, o mesmo microorganismo foi detectado tanto na cultura de cateteres quanto na hemocultura, sinalizando uma bacteremia devida ao cateter (9/79). Os parâmetros bioquímicos analisados não apresentaram diferenças significativas, enquanto que os parâmetros hematológicos (leucócitos, diferencial de bastonados e plaquetas) apresentaram diferenças significativas, demonstrando serem bons marcadores para o quadro séptico. Estes achados demonstraram uma importante relação entre a utilização de cateteres intravasculares e o desenvolvimento de bacteremia e sepse.
