Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury

Paolo Pelosi, Alessandra Barassi, Paolo Severgnini, Barbara Gomiero, Sergio Finazzi, Giampaolo Merlini, GianVico Melzi D'Eril, Maurizio Chiaranda, Michael S. Niederman

Research output: Contribution to journalArticlepeer-review


Background: We investigated the role of the clinical pulmonary infection score (CPIS), serum levels of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in the detection of patients with early ventilator-associated pneumonia (VAP). Methods: Observational study in a university hospital. In 58 patients with severe brain injury receiving mechanical ventilation, CPIS, PCT, CRP and SAA were evaluated at ICU entry and at days 3 to 4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or BAL cultures). Results: We found the following: (1) PCT at entry was increased in patients who later had early VAP develop (25 patients) compared to no VAP (median, 1.4 ng/mL; 25-75 percentiles, 0.14-0.78; vs median, 0.2 ng/mL; 25-75 percentiles, 0.76-2.4, p <0.001; sensitivity, 76%; and specificity, 75%); (2) CPIS increased at the day of VAP diagnosis, compared to entry (median, 6.6 ± 1.1 vs 1.5 ± 1.1, p <0.001; sensitivity, 97%; specificity, 100%), while other serum inflammatory markers did not change; and (3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS changes. Conclusions: PCT may be a useful marker to predict which patients subsequently have early VAP. The CPIS could help as an early way to detect the patients with early VAP and who need further diagnostic testing.

Original languageEnglish
Pages (from-to)101-108
Number of pages8
Issue number1
Publication statusPublished - Jul 2008


  • Brain injury
  • C-reactive protein
  • Clinical infection pulmonary score
  • Procalcitonin
  • Serum amyloid A
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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