Porto Alegre Hospital de Clínicas, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
J Bras Pneumol. 2011 Jul-Aug;37(4):495-503. doi: 10.1590/s1806-37132011000400012.
Levels of procalcitonin, midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal provasopressin (copeptin), and C-reactive protein (CRP), as well as Sequential Organ Failure Assessment (SOFA) scores, are associated with severity and described as predictors of outcome in ventilator-associated pneumonia (VAP). This study sought to compare the predictive value of these biomarkers for mortality in VAP.
An observational study of 71 patients with VAP. Levels of procalcitonin, MR-proANP, copeptin, and CRP, together with SOFA scores, were determined at VAP onset, designated day 0 (D0), and on day 4 of treatment (D4). Patients received empirical antimicrobial therapy, with modifications based on culture results. Patients who died before D28 were classified as nonsurvivors.
Of the 71 patients evaluated, 45 were classified as survivors. Of the 45 survivors, 35 (77.8%) received appropriate antimicrobial therapy, compared with 18 (69.2%) of the 26 nonsurvivors (p = 0.57). On D0 and D4, the levels of all biomarkers (except CRP), as well as SOFA scores, were lower in eventual survivors than in eventual nonsurvivors. For D0 and D4, the area under the ROC curve was largest for procalcitonin. On D0, MR-proANP had the highest positive likelihood ratio (2.71) and positive predictive value (0.60), but procalcitonin had the highest negative predictive value (0.87). On D4, procalcitonin had the highest positive likelihood ratio (3.46), the highest positive predictive value (0.66), and the highest negative predictive value (0.93).
The biomarkers procalcitonin, MR-proANP, and copeptin can predict mortality in VAP, as can the SOFA score. Procalcitonin alone has the greatest predictive power for such mortality.
降钙素原、中段心房利钠肽（MR-proANP）、C 端加压素（copeptin）和 C 反应蛋白（CRP）水平以及序贯器官衰竭评估（SOFA）评分与严重程度相关，并被描述为呼吸机相关性肺炎（VAP）结局的预测指标。本研究旨在比较这些生物标志物对 VAP 死亡率的预测价值。
对 71 例 VAP 患者进行观察性研究。在 VAP 发病时（设为第 0 天，D0）以及治疗第 4 天（D4）测定降钙素原、MR-proANP、copeptin 和 CRP 水平以及 SOFA 评分。患者接受经验性抗菌治疗，根据培养结果进行调整。在 D28 之前死亡的患者被归类为非幸存者。
在 71 例评估的患者中，45 例被归类为幸存者。在 45 例幸存者中，35 例（77.8%）接受了适当的抗菌治疗，而 26 例非幸存者中（69.2%）有 18 例接受了适当的抗菌治疗（p = 0.57）。在 D0 和 D4，最终幸存者的所有生物标志物（除 CRP 外）水平以及 SOFA 评分均低于最终非幸存者。对于 D0 和 D4，ROC 曲线下面积最大的是降钙素原。在 D0，MR-proANP 具有最高的阳性似然比（2.71）和阳性预测值（0.60），但降钙素原具有最高的阴性预测值（0.87）。在 D4，降钙素原具有最高的阳性似然比（3.46）、最高的阳性预测值（0.66）和最高的阴性预测值（0.93）。
降钙素原、MR-proANP 和 copeptin 等生物标志物以及 SOFA 评分可预测 VAP 患者的死亡率。降钙素原单独对这种死亡率的预测能力最大。
