Dept of Respiratory and Critical Care Medicine, Sotiria Chest Diseases Hospital, Athens, Greece.
Eur Respir J. 2010 Apr;35(4):805-11. doi: 10.1183/09031936.00051309. Epub 2009 Aug 28.
We evaluated the performance of procalcitonin (PCT) and C-reactive protein (CRP) threshold values and kinetics as predictors of ventilator-associated pneumonia (VAP) survival and septic shock development. 45 adult patients with VAP were studied. Serum CRP and PCT levels and the Sequential Organ Failure Assessment (SOFA) score were measured on days 1, 4 and 7 (D1, D4, D7) of VAP and their variations between different days (kinetics) were calculated (DeltaPCT, DeltaCRP). A multivariate logistic regression model was constructed with either VAP 28-day survival or septic shock development as dependent variables, and PCT values, CRP values, kinetics, age, sex, SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) II score as independent variables. No difference was found in CRP levels between survivors and nonsurvivors. Nonsurvivors had significantly higher PCT levels on D1 and D7. In the multivariate analysis, the only factors predicting VAP survival were DeltaPCT(7-1) (OR 7.23, 95% CI 0.008-0.468) and DeltaCRP(7-4) (OR 4.59, 95% CI 0.013-0.824). VAP patients who developed septic shock had significantly higher CRP levels on D1 and D7 and higher PCT levels on D1 and D4. The only factor predicting the development of septic shock was SOFA on D1 (OR 7.44, 95% CI 1.330-5.715). Neither PCT and CRP threshold values nor their kinetics can predict VAP survival or septic shock development.
我们评估了降钙素原（PCT）和 C 反应蛋白（CRP）阈值和动力学作为预测呼吸机相关性肺炎（VAP）生存和脓毒症性休克发展的指标。研究了 45 例成人 VAP 患者。在 VAP 的第 1、4 和 7 天（D1、D4、D7）测量血清 CRP 和 PCT 水平和序贯器官衰竭评估（SOFA）评分，并计算它们在不同天数之间的变化（动力学）（DeltaPCT、DeltaCRP）。使用 28 天 VAP 生存率或脓毒症性休克发展作为因变量，PCT 值、CRP 值、动力学、年龄、性别、SOFA 和急性生理学和慢性健康评估（APACHE）II 评分作为自变量，构建多变量逻辑回归模型。幸存者和非幸存者之间的 CRP 水平没有差异。非幸存者在 D1 和 D7 时 PCT 水平明显更高。在多变量分析中，唯一预测 VAP 生存率的因素是 DeltaPCT（7-1）（OR 7.23，95%CI 0.008-0.468）和 DeltaCRP（7-4）（OR 4.59，95%CI 0.013-0.824）。发生脓毒症性休克的 VAP 患者在 D1 和 D7 时 CRP 水平明显更高，在 D1 和 D4 时 PCT 水平明显更高。唯一预测脓毒症性休克发展的因素是 D1 时的 SOFA（OR 7.44，95%CI 1.330-5.715）。PCT 和 CRP 阈值及其动力学均不能预测 VAP 生存率或脓毒症性休克发展。
