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Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia

¹ Intensive Care Unit, Depts of ⁴ Biopathology, ⁵ Microbiology, and ⁶ Pneumology, Universal Hospital La Fe, and ² Intensive Care Unit, Sagunto Hospital, Sagunto, Valencia, ⁷ Evaluation, Support and Prevention Unit, and ³ Intensive and Intermediate Respiratory Care Unit, Pneumology Service, Thorax Clinic Institute, Clinic Hospital, Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain.

CORRESPONDENCE: A. Torres, Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, Villarroel, 170. E-08036 Barcelona, Spain, Fax

Keywords: C-reactive protein, procalcitonin, simplified Clinical Pulmonary Infection Scores, ventilator-associated pneumonia

Received: July 11, 2007
Accepted October 7, 2007

The utility of procalcitonin levels to improve the accuracy of clinical and microbiological parameters in diagnosing ventilator-associated pneumonia (VAP) was evaluated.

Sequential measurement of procalcitonin and C-reactive protein levels and the calculation of the simplified Clinical Pulmonary Infection Scores (CPIS) were performed in 44 patients mechanically-ventilated for >48 h with neither active infection for the duration or suspicion of VAP. Patients who developed extrapulmonary infection were excluded.

In total, 20 cases were suspected of having VAP and diagnosis was microbiologically confirmed in nine. In patients with confirmed VAP, procalcitonin levels were higher than in those without VAP. C-reactive protein levels and CPIS were lower in patients without suspected VAP, but could not discriminate confirmed and nonconfirmed suspicion of VAP. The best sensitivity and specificity (78 and 97%, respectively) corresponded to procalcitonin. The CPIS resulted in the same sensitivity, but had a lower specificity (80%). C-reactive protein had the worst sensitivity (56%), but a good specificity (91%). A CPIS 6 combined with serum levels of procalcitonin 2.99 ng·mL^–1 did not improve the sensitivity (67%), but resulted in 100% specificity.

Procalcitonin might be useful in the diagnosis of ventilator-associated pneumonia. Combined values of Clinical Pulmonary Infection Scores and procalcitonin below the cut-off points excluded false-positive diagnoses of ventilator-associated pneumonia.