评估胰石蛋白动力学作为呼吸机相关性肺炎预测指标的研究

Evaluation of the Kinetics of Pancreatic Stone Protein as a Predictor of Ventilator-Associated Pneumonia.

作者信息

Ceccato Adrian, Camprubí-Rimblas Marta, Bos Lieuwe D J, Povoa Pedro, Martin-Loeches Ignacio, Forné Carles, Areny-Balagueró Aina, Campaña-Duel Elena, Morales-Quinteros Luis, Quero Sara, Ramirez Paula, Esperatti Mariano, Torres Antoni, Blanch Lluis, Artigas Antonio

机构信息

Critical Care Center, Institut d'Investigació i Innovació Parc Taulí I3PT-CERCA, Hospital Universitari Parc Taulí, Univeristat Autonoma de Barcelona, 08208 Sabadell, Spain.

CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain.

出版信息

Biomedicines. 2023 Sep 29;11(10):2676. doi: 10.3390/biomedicines11102676.

DOI:10.3390/biomedicines11102676

PMID:37893050

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10604889/

Abstract

BACKGROUND

Ventilator-associated pneumonia (VAP) is a severe condition. Early and adequate antibiotic treatment is the most important strategy for improving prognosis. Pancreatic Stone Protein (PSP) has been described as a biomarker that increases values 3-4 days before the clinical diagnosis of nosocomial sepsis in different clinical settings. We hypothesized that serial measures of PSP and its kinetics allow for an early diagnosis of VAP.

METHODS

The BioVAP study was a prospective observational study designed to evaluate the role of biomarker dynamics in the diagnosis of VAP. To determine the association between repeatedly measured PSP and the risk of VAP, we used joint models for longitudinal and time-to-event data.

RESULTS

Of 209 patients, 43 (20.6%) patients developed VAP, with a median time of 4 days. Multivariate joint models with PSP, CRP, and PCT did not show an association between biomarkers and VAP for the daily absolute value, with a hazard ratio (HR) for PSP of 1.01 (95% credible interval: 0.97 to 1.05), for CRP of 1.00 (0.83 to 1.22), and for PCT of 0.95 (0.82 to 1.08). The daily change of biomarkers provided similar results, with an HR for PSP of 1.15 (0.94 to 1.41), for CRP of 0.76 (0.35 to 1.58), and for PCT of 0.77 (0.40 to 1.45).

CONCLUSION

Neither absolute PSP values nor PSP kinetics alone nor in combination with other biomarkers were useful in improving the prediction diagnosis accuracy in patients with VAP.

CLINICAL TRIAL REGISTRATION

Registered retrospectively on August 3rd, 2012. NCT02078999.

摘要

背景

呼吸机相关性肺炎（VAP）是一种严重疾病。早期且充分的抗生素治疗是改善预后的最重要策略。在不同临床环境中，胰石蛋白（PSP）已被描述为一种生物标志物，其在医院获得性脓毒症临床诊断前3 - 4天数值会升高。我们推测，连续检测PSP及其动力学变化有助于早期诊断VAP。

方法

BioVAP研究是一项前瞻性观察性研究，旨在评估生物标志物动态变化在VAP诊断中的作用。为确定重复检测的PSP与VAP风险之间的关联，我们使用了纵向和事件发生时间数据的联合模型。

结果

209例患者中，43例（20.6%）发生VAP，中位时间为4天。包含PSP、CRP和PCT的多变量联合模型未显示生物标志物每日绝对值与VAP之间存在关联，PSP的风险比（HR）为1.01（95%可信区间：0.97至1.05），CRP为1.00（0.83至1.22），PCT为0.95（0.82至1.08）。生物标志物的每日变化提供了类似结果，PSP的HR为1.15（0.94至1.41），CRP为0.76（0.35至1.58），PCT为0.77（0.40至1.45）。