Abstract
IntroductionClara cell protein 10 (CC-10) has been associated with inflammatory and infectious pulmonary diseases. This study evaluates CC-10 concentrations in bronchoalveolar lavage (BAL) fluid as a potential marker of ventilator-associated pneumonia (VAP).MethodsBetween January 2003 and December 2007, BAL fluid samples obtained from critically ill patients at the intensive care unit of the Maastricht University Medical Centre clinically suspected of having VAP were included. Patients were divided into two groups: (1) microbiologically confirmed VAP (the VAP group) and (2) microbiologically unconfirmed VAP (the non-VAP group). The concentration of CC-10 was measured by means of a commercially available enzyme-linked immunosorbent assay kit, and retrospective analysis was performed. Areas under the curve of receiver operating characteristic curves were calculated for CC-10 concentrations.ResultsA total of 196 patients (122 men, 74 women) were included. A total of 79 (40%) of 196 cases of suspected VAP were microbiologically confirmed. The median CC-10 concentration in the VAP group was 3,019 ng/mL (range, 282 to 65,546 ng/mL) versus 2,504 ng/mL (range, 62 to 30,240 ng/mL) in the non-VAP group (P = 0.03). There was no significant difference in CC-10 concentrations between patients treated with or without corticosteroids (P = 0.26) or antibiotic therapy (P = 0.9). The CC-10 concentration did not differ significantly between patients with Gram-positive versus Gram-negative bacteria that caused the VAP (P = 0.06). However, CC-10 concentrations did differ significantly between the late-onset VAP group and the non-VAP group.ConclusionsThe CC-10 concentration in BAL fluid yielded low diagnostic accuracy in confirming the presence of VAP.
Highlights
Clara cell protein 10 (CC-10) has been associated with inflammatory and infectious pulmonary diseases
Different biological markers (for example, soluble triggering receptor expressed on myeloid cells, procalcitonin, C-reactive protein) have been proposed as candidates for a rapid diagnostic test for ventilator-associated pneumonia (VAP), but all failed to sufficiently discriminate VAP from other respiratory conditions mimicking VAP [16,17,18,19,20]
Patients included in the study Between January 2003 and December 2007, 383 bronchoalveolar lavage (BAL) fluid samples were eligible for inclusion in this study
Summary
Clara cell protein 10 (CC-10) has been associated with inflammatory and infectious pulmonary diseases. This study evaluates CC-10 concentrations in bronchoalveolar lavage (BAL) fluid as a potential marker of ventilator-associated pneumonia (VAP). CC-10 has structural homology with rabbit uteroglobin, which has immunosuppressive, anti-inflammatory, antiprotease and antiphospholipase A2 activities [1,3,4] This profile suggests a possible anti-inflammatory role for human CC-10 [4]. The percentage of ICOs is not influenced by antibiotic therapy in the 72 hours prior to the BAL This makes it an important parameter for distinguishing VAP from non-VAP conditions [15]. Procalcitonin, C-reactive protein and sTREM-1 were previously investigated by our group in the same patient population as the one in the present study These markers could not accurately distinguish VAP from other respiratory conditions mimicking VAP [16,17]. The present study was designed to evaluate CC-10 in BAL fluid as a potential marker of VAP in critically ill patients in whom VAP is suspected
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