Open AccessPentraxin 3 as an early marker in diagnosis of ventilator associated pneumonia
Author(s) -
Ibrahim I. El-Mahalawy,
Amany S Ammar,
Waleed M Fathy,
Asmaa Esmail Salama,
Walaa Samy Mokhtar
Publication year - 2017
Publication title -
egyptian journal of chest diseases and tuberculosis/egyptian journal of chest diseases and tuberculosis
Language(s) - English
Resource type - Journals
eISSN - 2090-9950
pISSN - 0422-7638
DOI - 10.1016/j.ejcdt.2017.10.004
Subject(s) - medicine , receiver operating characteristic , pneumonia , ventilator associated pneumonia , predictive value , mechanical ventilation , bronchoalveolar lavage , area under the curve , positive predicative value , likelihood ratios in diagnostic testing , predictive value of tests , gastroenterology , lung
Objective: To assess the role of pentraxin 3 (PTX3) in early diagnosis of ventilator associated pneumonia (VAP).Background: The early diagnosis of VAP remains a challenge because the clinical signs and symptoms lack sensitivity and specificity and microbiological analysis and identification of organisms may take 48–72 h.Methods: This prospective randomized study was conducted on forty patients diagnosed with VAP by clinical pulmonary infection score (CPIS) admitted in the intensive care unit (ICU) of Menoufia University Hospitals. We measured the level of PTX 3 in serum and bronchoalveolar lavage (BAL) and the level of CRP within 24 h from intubation and mechanical ventilation then after the onset of VAP diagnosed by CPIS > 6.Results: VAP was diagnosed in 31 patients; 30 had BAL PTX 3 level ≥6 ng/ml with 96.7% sensitivity, 100% specificity,100% positive predictive value and 90% negative predictive value for pneumonia confirmed by Area under the receiver operating characteristic curve (AUCROC) analysis (AUCROC = 0.966, SE = .006, 95% CI = 0.985–1, P < .0001) and 27 had serum PTX 3 level ≥6 ng/ml with 87% sensitivity, 88.8% specificity, 96.4% positive predictive value and 66.6% negative predictive value for pneumonia confirmed by (AUCROC) analysis (AUCROC = 0.842, SE = .104, 95% CI = .639–1, p = .002) and 24 had CRP level ≥12 mg/l with 77.4% sensitivity, 33.3% specificity, 80% positive predictive value and 30% negative predictive value for pneumonia confirmed by (AUCROC) analysis (AUCROC = 0.590, SE = .1, 95% CI = .39–.79, p = .418).Conclusion: BAL PTX3 level ≥6 ng/ml is discriminative for microbiologically confirmed VAP, serum PTX3 is also sensitive but less than BAL PTX3