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Article Type

Original Study

Abstract

Objective The aim of this study was to determine the role of procalcitonin (PCT) and C-reactive protein (CRP) as predictors of survival in ventilator-associated pneumonia (VAP) and determine the most common micro-organisms involved in VAP in the Menofiya University Hospital ICU. Background The prediction of survival in VAP remains a major challenge. We evaluated the performance of clinical score [Sequential Organ Failure Assessment (SOFA)], PCT, and CRP threshold values and kinetics as predictors of VAP survival. Materials and methods A total of 50 patients with VAP were studied at the Menofiya University Hospital ICU. Acute Physiology And Chronic Health Evaluation II (APACHE II) score was assessed during first 24 h of admission; clinical pulmonary infection score was followed up in mechanically ventilated patients for diagnosis of VAP. SOFA score, serum CRP, and serum PCT were assessed on day 1, day 4, and day 7 of VAP diagnosis and were correlated with the 28-day survival/mortality. Patients who survived were considered survivors (group A), and patients who died before 28 days were considered nonsurvivors (group B). Results The 28-day mortality rate was 40%. The APACHE II score was significantly lower in survivors than nonsurvivors (P < 0.001). Serum PCT was significantly lower on days 4 and 7 in the survivor group (504.87 ± 267.28, 164.30 ± 98.56 pg/l, respectively) in comparison with the nonsurvivor group (930.30 ± 177.54, 897.35 ± 200.99 pg/l) with a P-value of less than 0.001. The SOFA score was significantly lower on days 1, 4, and 7 in the survivor group (5.73 ± 1.80, 4.57 ± 1.22, 3.63 ± 1.16) compared with the nonsurvivor group (7.95 ± 1.39, 8.60 ± 1.53, 9.85 ± 1.90, respectively), with a P-value of less than 0.001. Serum CRP was comparable on days 1, 4, and 7 days in the survivor (108.0 ± 55.93, 103.60 ± 43.69, 85.6 ± 58.68 mg/dl) and the nonsurvivor group (108.0 ± 46.39, 100.80 ± 51.41, 100.80 ± 58.06 mg/dl), respectively. Age was significantly higher in the nonsurvivors than the survivors (61.30 ± 15.60, 46.93 ± 18.25, respectively) (P = 0.002). Conclusion The SOFA score can predict survival in VAP. The serum level of PCT can be used for diagnosis of VAP. PCT kinetics can be used to assess prognosis in VAP patients. CRP is useful as a diagnostic but not as a prognostic biomarker in VAP.

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