ObjectiveTo investigate the clinical value of serum proadrenomedullin (pro-ADM) for diagnosis of ventilator-associated pneumonia(VAP). MethodsA prospective study was carried out in eighty-nine patients with clinically suspected diagnosis of VAP who underwent invasive mechanical ventilation between June 2014 and July 2015.The patients were divided into a VAP group (n=52) and a non-VAP group (n=37) according to clinical and microbiological culture results.The levels of serum pro-ADM were measured by sandwich ELISA on 1st, 3rd and 5th day of VAP suspicion.The diagnostic value of pro-ADM for VAP was assessed by receiver operating characteristic (ROC) curve analysis. ResultsOn 1st day, 3rd day and 5th day, the pro-ADM levels [3.10(2.21, 4.61) nmol/L, 3.01(2.04, 4.75)nmol/L and 1.85(1.12, 3.54)nmol/L, respectively] in the VAP group were significantly higher than those in the non-VAP group [1.53(1.07, 2.24)nmol/L, 1.52(1.05, 2.17) nmol/L and 1.26(1.02, 2.17) nmol/L, respectively] (all P < 0.05).For diagnosis of VAP, the area under the ROC curve (AUC) for pro-ADM on 1st, 3rd and 5th were 0.896 (95%CI 0.799-0.940), 0.863(95%CI 0.791-0.935) and 0.651 (95%CI 0.538-0.765), respectively.When using 2.53 nmol/L as the best cutoff on 1st day, pro-ADM had 84.6% sensitivity and 86.5% specificity.When using 2.40 nmol/L as the best cutoff on 3rd day, pro-ADM had 82.7% sensitivity and 83.8% specificity. ConclusionSerum level of pro-ADM in the diagnosis of VAP has good sensitivity and specificity, which may be used as a marker to diagnose VAP early.
Objective To explore the correlation between the levels of nitrite / nitrate( NO2 /NO3) in exhaled breath condensate ( EBC) and pulmonary infection in mechanically ventilated patients. Methods The clinical data from ventilated patients in critical care units of Peking University People’s Hospital from November 2006 to August 2007 were collected and analyzed. The patients’clinical pulmonary index score ( CPIS) were calculated. EBC of those patients were collected via endotracheal tube or tracheostomy cannula,and the concentrations of NO2 /NO3 were assayed. The level of NO2 /NO3 in different CPIS patients in 24 hours’ventilation, weaning proportion in 3 days and mortality in different NO2 /NO3 level patients were compared. The correlation of the CPIS and level of NO2 /NO3 were explored between survival and non-survival patients. Results A total of 76 patients were enroled. The NO2 /NO3 levels in patients of CPIS≤3, CPIS 3-6 and CPIS gt;6 in 24 hours of ventilation were ( 23. 31 ±5. 79) , ( 28. 72 ±9. 10) and ( 35. 42 ±12. 10) μmol / L respectively, with significantly differences between each other ( P lt; 0. 01) . The lower the patients’concentration of NO2 /NO3 was, the earlier the weaning and the lower the mortality were. The NO2 /NO3 levels on 4th and 7th day were detected in 24 survival patients and 23 non-survival patients. The difference of NO2 /NO3 levels between the survival patients and non-survival patients became significant on 7th day [ ( 29. 32 ±9. 52) μmol / L vs. ( 37. 22 ±12. 03) μmol / L, P lt; 0. 01] . Linear correlation analysis showed that the NO2 /NO3 level was positively correlated with CPIS ( r = 0. 76, P lt; 0. 01) . Conclusions The NO2 /NO3 level of EBC in ventilated patients is positively correlated to the severity of pulmonary infection, thus may be used as a new predictor for weaning and prognosis.
ObjectiveTo assess the value of simplified clinical pulmonary infection score (sCPIS) in predicting prognosis of patients with ventilator-associated pneumonia (VAP). MethodsThe clinical data of 52 patients with VAP,admitted in ICU between January 2011 and December 2012,were retrospectively analyzed. The sCPIS was calculated at the onset,and on 3rd,5th and 7th day after onset of VAP. Results24 cases survived and 28 cases died in 28-day's hospitalization. 28-day mortality was 53.8%. A significant decrease in sCPIS scores was found on 3rd,5th and 7th day after onset compared with at the onset of VAP in the survivors(4.8±1.2,4.0±1.1,3.3±1.6 vs. 5.5±1.4,P<0.05). An increase in sCPIS scores was found on 3rd,5th and 7th days after onset compared with at the onset of VAP in the non-survivors (6.8±1.3,7.5±1.4,7.8±1.2 vs. 5.8±1.5,P<0.05). The sCPIS determined at the time of VAP diagnosis and on 3rd,5th and 7th day after onset was significantly higher in the non-survivors than that in the survivors respectively (P<0.05). The duration of mechanical ventilation and the length of ICU stay were longer in the non-survivors than those in the survivors[(18.4±5.2) d vs. (12.0±4.1) d,(22.5±8.5) d vs. (16±6.3) d,P<0.05]. ConclusionSerial measurement of sCPIS is valuable in evaluating the severity of illness and predicting the prognosis.
Objective To investigate the influence of pulmonary infection on noninvasive ventilation ( NIV) therapy in hypercapnic acute respiratory failure ( ARF) due to acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) , and evaluate the predictive value of simplified version of clinical pulmonary infection score ( CPIS) for the efficacy of NIV therapy in ARF patients with AECOPD. Methods Eighty-four patients with ARF due to AECOPD were treated by NIV, and were divided into a successful group and an unsuccessful group by the therapeutic effect of NIV. The CPIS and simplified version of CPIS between two groups was compared. The predictive value of simplified version of CPIS for the efficacy of NIV wasevaluated using ROC curve analysis. Results The CPIS and the simplified version of CPIS of the successful treatment group ( 4. 0 ±2. 8, 3. 2 ±2. 4) were lower than those of the unsuccessful group ( 8. 0 ±2. 1, 7. 2 ±1. 8) significantly ( P =0. 006, 0. 007) . The area under ROC curve ( AUC) of CPIS and simplified version of CPIS were 0. 884 and 0. 914 respectively, the cut oint of CPIS and simplified version of CPIS were 6 ( sensitivity of 78. 0% , specificity of 91. 2% ) and 5 ( sensitivity of 80. 0% , specificity of 91. 2% ) respectively. Conclusions The level of pulmonary infection is an important influencing factor on the therapeutic effect of NIV in patients with ARF due to AECOPD. Simplified version of CPIS is a helpful predictor for the effect of NIV on ARF of AECOPD.