HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (19) Citing Articles via Google Scholar Google Scholar Articles by Póvoa, P. Articles by Sabino, H. Search for Related Content PubMed PubMed Citation Articles by Póvoa, P. Articles by Sabino, H.

C-reactive protein as a marker of ventilator-associated pneumonia resolution: a pilot study

Intensive Care Unit, Garcia de Orta Hospital, Almada, Portugal

CORRESPONDENCE: P. Póvoa, Unidade de Cuidados Intensivos, Hospital Garcia de Orta, Av. Prof. Torrado da Silva, 2800-525 Almada, Portugal. Fax: 351 212957004. E-mail: povoap@netcabo.pt

Keywords: C-reactive protein, intensive care unit, outcome, temperature, ventilator-associated pneumonia, white cell count

Received: June 15, 2004
Accepted December 13, 2004

The aim of this study was to evaluate C-reactive protein (CRP) levels, body temperature and white cell count (WCC) after prescription of antibiotics in order to describe the clinical resolution of ventilator-associated pneumonia (VAP).

A cohort of 47 VAP patients with microbiological confirmation of disease was assessed. CRP levels, body temperature and WCC were monitored daily.

On day 4 of the antibiotic therapy, the CRP level of survivors was 0.62 times the initial value, whereas, in nonsurvivors, it was 0.98. Body temperature and WCC remained almost unchanged. By day 4, a CRP of >0.6 times the initial level was a marker of poor outcome (sensitivity 0.92; specificity 0.59). Patients were divided according to their CRP patterns of response to antibiotics: fast response, slow response, nonresponse, and biphasic response. All patients with fast and slow response patterns survived, whereas those showing nonresponse and a biphasic response pattern exhibited a mortality of 78 and 75%, respectively. The adequacy of the initial antibiotic therapy had a marked influence on the rate of CRP decrease, as well as on mortality.

In conclusion, daily C-reactive protein measurements after antibiotic prescription were useful in the identification, as early as day 4, of ventilator-associated pneumonia patients with poor outcome. The identification of the pattern of C-reactive protein response to antibiotics was useful in the recognition of individual clinical course, improving or worsening, as well as of the rate of improvement.

This article has been cited by other articles:

				C. F M Linssen, O. Bekers, M. Drent, and J. A Jacobs C-reactive protein and procalcitonin concentrations in bronchoalveolar lavage fluid as a predictor of ventilator-associated pneumonia Ann Clin Biochem, May 1, 2008; 45(3): 293 - 298. [Abstract] [Full Text] [PDF]

				R Menendez, M Cavalcanti, S Reyes, J Mensa, R Martinez, M A Marcos, X Filella, M Niederman, and A Torres Markers of treatment failure in hospitalised community acquired pneumonia Thorax, May 1, 2008; 63(5): 447 - 452. [Abstract] [Full Text] [PDF]

				J. Poelaert, P. Depuydt, A. De Wolf, S. Van de Velde, I. Herck, and S. Blot Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: A pilot study. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 771 - 776. [Abstract] [Full Text] [PDF]

				P. Ramirez, M. A. Garcia, M. Ferrer, J. Aznar, M. Valencia, J. M. Sahuquillo, R. Menendez, M. A. Asenjo, and A. Torres Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia Eur. Respir. J., February 1, 2008; 31(2): 356 - 362. [Abstract] [Full Text] [PDF]

				R. Menendez and A. Torres Treatment Failure in Community-Acquired Pneumonia Chest, October 1, 2007; 132(4): 1348 - 1355. [Abstract] [Full Text] [PDF]

				R. Isozumi, Y. Ito, T. Ishida, M. Osawa, T. Hirai, I. Ito, K. Maniwa, M. Hayashi, H. Kagioka, M. Hirabayashi, et al. Genotypes and Related Factors Reflecting Macrolide Resistance in Pneumococcal Pneumonia Infections in Japan J. Clin. Microbiol., May 1, 2007; 45(5): 1440 - 1446. [Abstract] [Full Text] [PDF]

				E. B. Milbrandt, A. Ishizaka, and D. C. Angus Update in critical care 2005. Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 833 - 841. [Full Text] [PDF]

				S. Teramoto, T. Ishii, H. Yamamoto, Y. Yamaguchi, and Y. Ouchi Nasogastric tube feeding is a cause of aspiration pneumonia in ventilated patients Eur. Respir. J., February 1, 2006; 27(2): 436 - 437. [Full Text] [PDF]