Surgical Intensive Care Unit, Hotel-Dieu, University Hospital of Nantes, 44093, Nantes, France.
EA3826 Therapeutiques Anti-Infectieuses, Institut de Recherche en Sante 2 Nantes Biotech, Medical University of Nantes, 44000, Nantes, France.
Crit Care. 2019 Dec 5;23(1):394. doi: 10.1186/s13054-019-2680-6.
To propose a combination of blood biomarkers for the prediction of hospital-acquired pneumonia (HAP) and for the selection of traumatic brain-injured (TBI) patients eligible for corticosteroid therapy for the prevention of HAP.
This was a sub-study of the CORTI-TC trial, a multicenter, randomized, double-blind, controlled trial evaluating the risk of HAP at day 28 in 336 TBI patients treated or not with corticosteroid therapy. Patients were between 15 and 65 years with severe traumatic brain injury (Glasgow coma scale score ≤ 8 and trauma-associated lesion on brain CT scan) and were enrolled within 24 h of trauma. The blood levels of CRP and cortisol as a surrogate marker of the pro/anti-inflammatory response balance, were measured in samples collected before the treatment initiation. Endpoint was HAP on day 28.
Of the 179 patients with available samples, 89 (49.7%) developed an HAP. Cortisol and CRP blood levels upon ICU admission were not significantly different between patients with or without HAP. The cortisol/CRP ratio upon admission was 2.30 [1.25-3.91] in patients without HAP and 3.36 [1.74-5.09] in patients with HAP (p = 0.021). In multivariate analysis, a cortisol/CRP ratio > 3, selected upon the best Youden index on the ROC curve, was independently associated with HAP (OR 2.50, CI95% [1.34-4.64] p = 0.004). The HR for HAP with corticosteroid treatment was 0.59 (CI95% [0.34-1.00], p = 0.005) in patients with a cortisol/CRP ratio > 3, and 0.89 (CI95% [0.49-1.64], p = 0.85) in patients with a ratio < 3.
A cortisol/CRP ratio > 3 upon admission may predict the development of HAP in severe TBI. Among these patients, corticosteroids reduce the occurrence HAP. We suggest that this ratio may select the patients who may benefit from corticosteroid therapy for the prevention of HAP.
提出一种血液生物标志物组合，用于预测医院获得性肺炎（HAP），并选择外伤性脑损伤（TBI）患者接受皮质类固醇治疗以预防 HAP。
这是 CORTI-TC 试验的一项子研究，该试验是一项多中心、随机、双盲、对照试验，评估了 336 例 TBI 患者接受或不接受皮质类固醇治疗后第 28 天发生 HAP 的风险。患者年龄在 15 至 65 岁之间，有严重的外伤性脑损伤（格拉斯哥昏迷评分≤8 分，脑 CT 扫描显示与创伤相关的病变），并在创伤后 24 小时内入组。在开始治疗前采集样本，测量 C 反应蛋白（CRP）和皮质醇的血液水平，作为促炎/抗炎反应平衡的替代标志物。主要终点为第 28 天 HAP。
在有可用样本的 179 例患者中，89 例（49.7%）发生了 HAP。HAP 患者和无 HAP 患者入院时的皮质醇和 CRP 血液水平无显著差异。入院时皮质醇/CRP 比值在无 HAP 患者中为 2.30[1.25-3.91]，在 HAP 患者中为 3.36[1.74-5.09]（p=0.021）。多变量分析显示，入院时根据 ROC 曲线最佳约登指数选择的皮质醇/CRP 比值>3 与 HAP 独立相关（OR 2.50，95%CI [1.34-4.64]，p=0.004）。入院时皮质醇/CRP 比值>3 的患者接受皮质类固醇治疗的 HAP 风险比（HR）为 0.59（95%CI [0.34-1.00]，p=0.005），比值<3 的患者为 0.89（95%CI [0.49-1.64]，p=0.85）。
入院时皮质醇/CRP 比值>3 可能预测严重 TBI 患者发生 HAP。在这些患者中，皮质类固醇可降低 HAP 的发生。我们建议，该比值可能选择那些可能受益于皮质类固醇治疗以预防 HAP 的患者。
