Abstract
Ventilator associated pneumonia affects mortality, morbidity and cost of critical care. Reliable risk estimation might improve end of life decisions, resource allocation and outcome. Several scoring systems for survival prediction have been established and optimized over the last decades. Recently, new biomarkers gain interest in the prognostic field. We assessed whether MR-proANP and procalcitonin improve the predictive value of SAPS II and SOFA in ventilator associated pneumonia.
Specified endpoints of a prospective multinational trial including 101 patients with ventilator associated pneumonia were analysed. Death within 28 days after ventilator associated pneumonia onset was the primary endpoint.
MR-proANP and procalcitonin on ventilator associated pneumonia onset were elevated in non-survivors as compared to survivors (p=0.003 and p=0.017, respectively) and their slope of decline differed significantly (p=0.018 and p=0.039, respectively). Patients with the highest MR-proANP quartile at ventilator associated pneumonia onset were at increased risk for death (log rank p=0.013). In a logistic regression model, MR-proANP was identified as the best predictor of survival. Adding MR-proANP and procalcitonin to SAPS II and SOFA improved their predictive properties (AUC 0.895 and 0.880).
We conclude that the combination of two biomarkers, MR-proANP and procalcitonin, improves survival prediction of clinical severity scores in ventilator associated pneumonia.
- ERS