Pedro Póvoa1, Ignacio Martin-Loeches2, Paula Ramirez3, Lieuwe D Bos4, Mariano Esperatti5, Joana Silvestre6, Gisela Gili7, Gemma Goma8, Eugenio Berlanga9, Mateu Espasa10, Elsa Gonçalves11, Antoni Torres12, Antonio Artigas13. 1. Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal. Electronic address: povoap@netcabo.pt. 2. Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: drmartinloeches@gmail.com. 3. CIBER de Enfermedades Respiratorias (CIBERES), Spain; Intensive Care Unit, University Hospital La Fe, Valencia, Spain. Electronic address: ramirez_pau@gva.es. 4. Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: lieuwe.bos@gmail.com. 5. CIBER de Enfermedades Respiratorias (CIBERES), Spain; Intensive Care Unit, Hospital Privado de Comunidad, Mar del Plata, Argentina. Electronic address: marianoesperatti@gmail.com. 6. Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal. Electronic address: joanapsilvestre@gmail.com. 7. Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: Gisela.gili@vhir.org. 8. Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: ggoma@tauli.cat. 9. Laboratory Department, UDIAT, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Spain. Electronic address: eberlanga@tauli.cat. 10. Laboratory Department, UDIAT, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Spain. Electronic address: mespasa@tauli.cat. 11. NOVA Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal; Microbiology Department, Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. Electronic address: elsa.a.goncalves@sapo.pt. 12. CIBER de Enfermedades Respiratorias (CIBERES), Spain; Respiratory Disease Department, Hospital Clínic i Provincial de Barcelona, IDIBAPS, Barcelona, Spain. Electronic address: atorres@ub.edu. 13. Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: aartigas@tauli.cat.
Abstract
PURPOSE: Our aim was to evaluate the role of biomarker kinetics in the assessment of ventilator-associated pneumonia (VAP) response to antibiotics. MATERIALS AND METHODS: We performed a prospective, multicenter, observational study to evaluate in 37 microbiologically documented VAP, the kinetics of C-reactive protein (CRP), procalcitonin (PCT), mid-region fragment of pro-adrenomedullin (MR-proADM). The kinetics of each variable, from day 1 to 6 of therapy, was assessed with a time dependent analysis comparing survivors and non-survivors. RESULTS: During the study period kinetics of CRP as well as its relative changes, CRP-ratio, was significantly different between survivors and non-survivors (p=0.026 and p=0.005, respectively). On day 4 of antibiotic therapy, CRP of survivors was 47% of the initial value while it was 96% in non-survivors. The kinetics of other studied variables did not distinguish between survivors and non-survivors. In survivors the bacterial load also decreased markedly. Adequate initial antibiotic therapy was associated with lower mortality (p=0.025) and faster CRP decrease (p=0.029). CONCLUSIONS: C-reactive protein kinetics can be used to identify VAP patients with poor outcome as soon as four days after the initiation of treatment. (Trial registration - NCT02078999; registered 3 August 2012).
PURPOSE: Our aim was to evaluate the role of biomarker kinetics in the assessment of ventilator-associated pneumonia (VAP) response to antibiotics. MATERIALS AND METHODS: We performed a prospective, multicenter, observational study to evaluate in 37 microbiologically documented VAP, the kinetics of C-reactive protein (CRP), procalcitonin (PCT), mid-region fragment of pro-adrenomedullin (MR-proADM). The kinetics of each variable, from day 1 to 6 of therapy, was assessed with a time dependent analysis comparing survivors and non-survivors. RESULTS: During the study period kinetics of CRP as well as its relative changes, CRP-ratio, was significantly different between survivors and non-survivors (p=0.026 and p=0.005, respectively). On day 4 of antibiotic therapy, CRP of survivors was 47% of the initial value while it was 96% in non-survivors. The kinetics of other studied variables did not distinguish between survivors and non-survivors. In survivors the bacterial load also decreased markedly. Adequate initial antibiotic therapy was associated with lower mortality (p=0.025) and faster CRP decrease (p=0.029). CONCLUSIONS:C-reactive protein kinetics can be used to identify VAP patients with poor outcome as soon as four days after the initiation of treatment. (Trial registration - NCT02078999; registered 3 August 2012).