Abstract
Ventilator-associated pneumonia (VAP) leads to increased patients’ mortality and medical expenditure. Monocyte chemoattractant protein-1 (MCP-1) plays a role in the pathogenesis of lung inflammation and infection. Therefore, the plasma concentration of MCP-1 was assessed and correlated with the clinical course in VAP patients. This retrospective observational study recruited 45 healthy volunteers, 12 non-VAP subjects, and 30 VAP patients. The diagnostic criteria for VAP were based on the American Thoracic Society guidelines, and the level of plasma MCP-1 was determined by ELISA. Plasma MCP-1 concentration was significantly elevated in the acute stage in VAP patients when compared with the control (p < 0.0001) and non-VAP patient groups (p = 0.0006). Subsequently, it was remarkably decreased following antibiotic treatment. Moreover, plasma MCP-1 concentration was positively correlated with indices of pulmonary dysfunction, including the lung injury score (p = 0.02) and the oxygenation index (p = 0.02). When patients with VAP developed adult respiratory distress syndrome (ARDS), their plasma MCP-1 concentrations were significantly higher than those of patients who did not develop ARDS (p = 0.04). Moreover, plasma MCP-1 concentration was highly correlated with organ failure scores, including simplified acute physiology score II (SAPS II, p < 0.0001), sequential organ failure assessment score (SOFA, p < 0.0001), organ dysfunctions and/or infection (ODIN, p < 0.0001), predisposition, insult response and organ dysfunction (PIRO, p = 0.005), and immunodeficiency, blood pressure, multilobular infiltrates on chest radiograph, platelets and hospitalization 10 days before onset of VAP (IBMP-10, p = 0.004). Our results demonstrate that plasma MCP-1 is an excellent marker for recognizing VAP when the cut-off level is set to 347.18 ng/mL (area under the curve (AUC) = 0.936, 95% CI = 0.863–0.977). In conclusion, MCP-1 not only could be a biological marker related to pulmonary dysfunction, organ failure, and mortality in patients with VAP, but also could be used for early recognition of VAP.
Highlights
Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia occurring more than 48 h after invasive mechanical ventilator support and is one of the most frequently diagnosed infectious diseases in the intensive care unit (ICU) [1,2]
The results showed that APACH II score, simplified acute physiology score II (SAPS II), organ dysfunctions and/or infection (ODIN), SOFA, CPIS, PIRO, IBMP-10 scores (p < 0.0001), and Charlson comorbidity index (p = 0.01) were significantly higher in patients with VAP than in patients without VAP
We discovered that plasma Monocyte chemoattractant protein-1 (MCP-1) was significantly increased in VAP patients
Summary
Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia occurring more than 48 h after invasive mechanical ventilator support and is one of the most frequently diagnosed infectious diseases in the intensive care unit (ICU) [1,2]. The ODIN predicts the prognosis of critical patients based upon 12 variables of failure types derived from 6 organ systems and the infection status [13,14], and the APACHE II score provides a general measurement of disease severity employing 12 regular physiological factors, age, and previous health status as determined by the worst value during the initial 24 h of ICU admission [15,16]. They were used to predict mortality risk in patients with VAP
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
