Validity of the D4 D0 plasma procalcitonin level ratio as a predictor for mortality in ventilation-associated pneumonia patients

Abstract EN

Objectives To evaluate the plasma procalcitonin (PCT) levels estimated at the time of (D0) and 4 days (D4) after the diagnosis of ventilator-associated pneumonia (VAP) as a predictor for mortality.

Patients and methods VAP was diagnosed when pneumonia developed after 48 h of mechanical ventilation.

Patients were evaluated clinically using the APACHE II score and septic status was graded according to Bone’s criteria.

Blood samples were obtained D0 and D4 for the estimation of plasma PCT levels.

Patients were categorized into two groups: survivors, that is, patients discharged through or at the end of 28 days (day 28), and nonsurvivors.

Clinical data, plasma PCT levels and the D4/D0 ratio were analyzed as predictors for mortality.

Results The study included 40 patients, but 15 patients died, yielding a mortality rate of 37.5%.

The mean duration of mechanical ventilation before D0 (day of VAP diagnosis) was 5 ±1.5 days; 29 patients developed early VAP, whereas 11 patients developed late VAP.

The mean D0 and D4 plasma PCT levels were significantly higher in all the patients compared with the control levels.

The mean D4 plasma PCT levels were significantly higher in all the patients studied and in the patients categorized according to outcome compared with D0 levels and in nonsurvivors compared with survivors.

The mean D0/D4 ratio of PCT plasma levels was significantly higher in nonsurvivors compared with survivors.

Receiver operating characteristic curve analysis defined the D4/D0 plasma PCT ratio and severity of sepsis as significant predictors for mortality, but the difference was more significant for the D4/D0 ratio.

Conclusion VAP is associated with a high mortality rate and estimated levels of plasma PCT were significantly higher in nonsurvivors despite treatment compared with survivors.

A high D4/D0 ratio of plasma PCT levels was found to be a highly specific predictor of mortality among VAP patients.