Introduction
Materials and methods
Patients
Characteristic | All patientsa (n = 207) | Patients with confirmed VAP (n = 90) | Patients without confirmed VAP (n = 117) |
P value (two groups compared) |
---|---|---|---|---|
Sex | ||||
Male (%) | 130 (62.8) | 54 (60) | 76 (65) | 0.46 |
Female (%) | 77 (37.2) | 36 (40) | 41 (35) | |
Age, years, median (interquartile range) | 62 (47–72) | 65.50 (47–73.25) | 61 (47.50–71) | 0.43 |
Days in hospital | ||||
Mean (± SEM) | 68.0 (4.6) | 75.7 (9.0) | 62.1 (4.2) | 0.76 |
Range | 6–540 | 6–540 | 8–322 | |
Days in ICU | ||||
Mean (± SEM) | 39.8 (2.8) | 45.1 (5.7) | 35.8 (2.3) | 0.77 |
Range | 6–397 | 6–397 | 7–168 | |
Days in ICU before BALb
| ||||
Mean (± SEM) | 15.5 (0.9) | 15.3 (1.5) | 15.7 (1.2) | 0.63 |
Range | 2–83 | 3–83 | 2–73 | |
APACHE II scorec
| ||||
Mean (± SEM) | 23 (0.5) | 23 (0.9) | 23 (0.6) | 0.83 |
Range | 4–44 | 4–44 | 7–40 | |
Mortality in ICU (%) | 72 (34.8) | 33 (36.7) | 39 (33.3) | 0.62 |
Mortality in hospital (%) | 83 (40.1) | 41 (45.6) | 42 (35.9) | 0.16 |
History of COPD (%) | 10 (4.8) | 5 (5.6) | 5 (4.3) | 0.67 |
Medical specialty (%) | ||||
Medical | 71 (34.3) | 24 (26.7) | 47 (40.2) | 0.26 |
Surgical | 78 (37.7) | 35 (38.9) | 43 (36.8) | |
Trauma | 34 (16.4) | 19 (21.1) | 15 (12.8) | |
Neurological | 18 (8.7) | 9 (10.0) | 9 (7.7) | |
Otherd
| 6 (2.9) | 3 (3.3) | 3 (2.6) | |
Reason for ICU admission (%) | ||||
Respiratory insufficiency | 25 (12.1) | 10 (11.1) | 15 (12.8) | 0.21 |
Trauma | 28 (13.5) | 15 (16.7) | 13 (11.1) | |
Shock | 52 (25.1) | 19 (21.1) | 33 (28.2) | |
Cardiopulmonary failure | 17 (8.2) | 4 (4.4) | 13 (11.1) | |
Pneumonia | 32 (15.5) | 13 (14.4) | 19 (16.2) | |
Neurological disease | 15 (7.2) | 7 (7.8) | 8 (6.8) | |
Post-operative | 38 (18.4) | 22 (24.4) | 16 (13.7) |
VAP diagnosis
Bronchoalveolar lavage
Soluble Triggering Receptor Expressed on Myeloid cells-1 assay
Statistical analysis
Results
Patients
Soluble Triggering Receptor Expressed on Myeloid cells-1 levels
Diagnostic value of sTREM-1
Discussion
Study factors | Gibot [3] | Determann [7] | Horonenko [8] | Huh [9] | Anand [10] | Present study |
---|---|---|---|---|---|---|
Number of cases | 148 | 28 | 23 | 80 | 105 | 240 |
Setting | Medical ICU | General ICU | Medical ICU | Medical ICU | Medical ICU | General ICU |
Assay | Immunoblot | ELISA | ELISA | ELISA | ELISA | ELISA |
Correction for dilution | No | No | Yes | No | No | Yes |
Type of BAL | Mini-BAL | Non-directed | BAL, NS | Non-directed | Directed | Directed |
Sensitivity/specificity | 98/90 | 75/84 | NS | 86/90 | 42/76 | 65/48 |
Diagnosis | CAP/VAP | VAP | VAP | Bilateral lung infiltrates | VAP | VAP |
Confirmation of VAP | >103 cfu/ml | ≥104 cfu/ml | ≥103 cfu/ml | >104 cfu/ml | >103 cfu/ml | ≥104 cfu/ml and/or ≥2% ICO |
Patients with confirmed VAP (%) | 46 (31) | 9 (32) | 14 (61) | 29 (36) | 19 (18) | 90 (43) |
Mean sTREM-1 level (pg/ml) VAP patientsa
| 34 | 894 | 403 | 521 | 172 | 227 |