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Published ahead of print on September 24, 2004, doi:10.1164/rccm.200406-746OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 1, January 2005, 48-53

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Submitted on June 13, 2004
Accepted on September 21, 2004

Procalcitonin Kinetics as a Prognostic Marker of Ventilator-Associated Pneumonia

Charles-Edouard Luyt1*, Valerie Guerin2, Alain Combes1, Jean-Louis Trouillet1, Said Ben Ayed2, Maguy Bernard2, Claude Gibert1, and Jean Chastre1

1 Service de Reanimation Medicale, Groupe Hospitalier Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Universite Paris 6, Paris, France, 2 Service de Biochimie, Groupe Hospitalier Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Universite Paris 6, Paris, France

* To whom correspondence should be addressed. E-mail: charles-edouard.luyt{at}psl.ap-hop-paris.fr.

We investigated the value of procalcitonin kinetics as a prognostic marker during ventilator-associated pneumonia. This prospective, observational study was conducted in a medical intensive care unit in a university hospital. All consecutive patients with microbiologically proven ventilator-associated pneumonia who survived 3 days after its diagnosis were included and grouped according to clinical outcome: favorable, or unfavorable, defined as death, ventilator-associated pneumonia recurrence or extrapulmonary infection requiring antibiotics before day 28. Serum procalcitonin levels were measured on days 1, 3 and 7 for all patients. Among the 63 patients included, 38 had unfavorable outcomes. On day 1, they were more critically ill than favorable-outcome patients. Serum procalcitonin levels decreased during the clinical course of ventilator-associated pneumonia but were significantly higher from day 1 to day 7 in patients with unfavorable outcomes. Multivariate analyses retained serum procalcitonin levels on days 1, 3 and 7 as strong predictors of unfavorable outcome. Based on these data, procalcitonin could be a prognostic marker of outcome during ventilator-associated pneumonia.patients whose treatment failed. Multivariate analyses retained serum procalcitonin levels on days 1, 3 and 7 as strong predictors of treatment failure. Based on these data, procalcitonin could be a prognostic marker of treatment failure during ventilator associated pneumonia.
Key words: ventilator-associated pneumonia, procalcitonin, prognosis




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