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Subject Area

Clinical Pathology

Article Type

Original Study

Abstract

Objective The aim of this study was to assess the role of pentraxin3 (PTX3) in the early diagnosis of ventilator-associated pneumonia (VAP). Background The early diagnosis of VAP remains a challenge because the clinical signs and symptoms lack sensitivity and specificity and because microbiological analysis and identification of organisms may take 48–72 h. Patients and methods This prospective randomized study was carried out on 40 patients diagnosed with VAP using clinical pulmonary infection score in Menoufia University Hospital's ICU. We measured the level of PTX3 in serum and bronchoalveolar lavage and the level of C-reactive protein within 24 h from intubation and mechanical ventilation and after the onset of VAP diagnosed using clinical pulmonary infection score more than 6. Results The study showed that VAP was diagnosed in 31 patients; 30 had bronchoalveolar lavage PTX3 level of at least 6 ng/ml with 96.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 90% negative predictive value (NPV) for pneumonia confirmed using area under the receiver operating characteristic curve (AUCROC) analysis [AUCROC= 0.966, SE = 0.006, 95% confidence interval (CI)=0.985–1, P < 0.0001]; 27 had serum PTX3 level of at least 6 ng/ml with 87% sensitivity, 88.8% specificity, 96.4% PPV, and 66.6% NPV for pneumonia confirmed using AUCROCanalysis (AUCROC= 0.842, SE = 0.104, 95% CI = 0.639–1, P = 0.002); and 24 had C-reactive protein level of at least 12 mg/l with 77.4% sensitivity, 33.3% specificity, 80% PPV, and 30% NPV for pneumonia confirmed using AUCROCanalysis (AUCROC= 0.590, SE = 0.1, 95% CI = 0.39–0.79, P = 0.418). Conclusion Alveolar PTX3 level of at least 6 ng/ml is discriminative for microbiologically confirmed VAP; serum PTX3 is also sensitive but to a lower extent than alveolar PTX3.

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