Alveolar and serum procalcitonin - Diagnostic and prognostic value in ventilator-associated pneumonia

Background: The potential role of serum and alveolar procalcitonin as early markers of ventilator-associated pneumonia (VAP) and its prognostic value were investigated. Methods: Ninety-six patients with a strong suspicion of VAP were prospectively enrolled. VAP diagnosis was based on a positive quantitative culture obtained via a mini-bronchoalveolar lavage of 10(3) colony-forming units/ml or more. Blood and alveolar samples were collected for procalcitonin measurement and analyzed for diagnostic and prognostic evaluation on days 0, 3, and 6. Sensitivity, specificity, positive likelihood ratio, and receiver-operating characteristic curves were analyzed to define ideal cutoff values and approach the decision analysis. Results: Serum procalcitonin was significantly increased in the VAP group (n = 44) compared with the non-VAP group (n = 52): 11.5 ng/ml (95% confidence interval, 5.9-17.0) versus 1.5 ng/ml (1.1-1.9). A serum procalcitonin concentration greater than 3.9 ng/ml (best cutoff was considered positive for the VAP diagnosis (sensitivity, 41%; specificity, 100%). Serum procalcitonin was significantly increased in the non-survivors compared with the survivors for the VAP group: 16.5 ng/ml (95% confidence interval, 8.1-24.9) versus 2.9 ng/ml (1.2-4.7). The best cutoff value for serum procalcitonin of the nonsurvivors in the VAP group was 2.6 ng/ml (sensitivity, 74% specificity, 750,; positive likelihood ratio, 2.96). Regarding diagnosis and prognosis, no significant differences were found for alveolar procalcitonin in all groups. Conclusions: Serum but not alveolar procalcitonin seems to be a helpful parameter in the early VAP diagnosis and an appropriate marker for predicting mortality.