|Volume 7 Issue 3 Published - 14:00 UTC 08:00 EST 3-Jan-2005 Next Update - 14:00 UTC 08:00 EST 4-Jan-2005||Editor: Susan K. Boyer, RN
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A prognostic marker for outcome in ventilator-associated pneumonia
Higher procalcitonin levels on days 1, 3, and 7 following diagnosis are strong predictors of unfavorable outcome in microbiologically confirmed ventilator-associated pneumonia (VAP), the most frequent hospital-acquired infection in patients on mechanical ventilation.
The investigators studied procalcitonin as a prognostic marker in VAP among 63 patients enrolled in the study. Among the 63 patients, 38 (60 percent) had unfavorable outcomes. There were 14 deaths, 21 recurrences, and 3 documented extra-pulmonary infections, with the average time to unfavorable outcome at about 16 days.
Their results showed that serum procalcitonin concentrations decreased during the clinical course of VAP but were higher in patients with unfavorable outcomes than in those with favorable results. (Procalcitonin is the precursor molecule of calcitonin, which regulates calcium concentrations in the blood. Procalcitonin levels rise during bacterial infections but not during either viral infections or inflammatory reactions of a non-infectious origin. Serum levels of procalcitonin are very low in healthy individuals.)
Other clinical and biologic factors, such as white blood cell counts or C-reactive protein, were not able to discriminate between patients whose outcome would be unfavorable, as compared with favorable outcomes.
The investigators commented that early identification of patients at high risk of death or VAP recurrence could provide an opportunity to change the treatment strategy to improve outcome. The study is available in the American Journal of Respiratory and Critical Care Medicine, January 2005.