Luyt CE et Al

Luyt CE, Combes A, Reynaud C, Hekimian G, Nieszkowska A, Tonnellier M, Aubry A, Trouillet JL, Bernard M, Chastre J.

Service de Réanimation Médicale, Groupe Hospitalier Pitié Salpêtrière, AP-HP, Université Paris, France.

Intensive Care Med. 2008 Aug;34(8):1434-40.

OBJECTIVE: To assess the predictive capacity for the diagnosis of ventilator-associated pneumonia (VAP) of serum procalcitonin levels before and on the day it is suspected.

DESIGN AND SETTING: Single-center observational study in the intensive care unit of a teaching hospital.

PATIENTS AND PARTICIPANTS: Consecutive patients whose serum procalcitonin levels were available on the day that VAP was clinically suspected (day 1) and at some time within the preceding 5 days ("before").

MEASUREMENTS AND RESULTS: Serum procalcitonin levels were determined on day 1 and "before". Among the 73 suspected episodes VAP was confirmed by quantitative bronchoalveolar lavage cultures in 32 and refuted in 41. Respective median "before" procalcitonin levels were 1.89 ng/ml (interquartile range 0.18-6.01) and 2.14 (0.76-5.75) in patients with and without VAP, but their respective median day-1 procalcitonin levels did not differ: 1.07[Symbol: see text]ng/ml (0.39-6.57) vs. 1.40 (0.67-3.39). On day 1 a 0.5[Symbol: see text]ng/ml procalcitonin threshold had 72% sensitivity but only 24% specificity for diagnosing VAP. Between "before" and day 1, procalcitonin increased in 41% and 15% of patients with and without VAP, respectively. Thus a procalcitonin rise on day 1, compared to its "before" level, had 41% sensitivity and 85% specificity for diagnosing VAP, with respective positive and negative predictive values of 68% and 65%.

CONCLUSIONS: Crude values and procalcitonin rise had poor diagnostic value for VAP in this particular setting and thus should not be used to initiate antibiotics when VAP is clinically suspected.