PSP kinetics in the prediction of VAP diagnosis

Abstract

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the ICU. Early, adequate antibiotic treatment reduces complications and associated mortality. Pancreatic stone protein (PSP) may start to increase above the normal level range before the development of clinical signs and symptoms of sepsis. We aimed to evaluate the predictive performance of kinetic of PSP to VAP development in all non-infected patients during the first days of mechanical ventilation. <b>Methods:</b> This was a post hoc study of the observational, multicenter, prospective BioVAP study.&nbsp;Patients were included when they were on mechanical ventilation for &gt;72 h, and no infections were suspected. PSP was measured in frozen samples taken on consecutive days during mechanical ventilation duration. The kinetics of each variable, from day 1 to day 6 of mechanical ventilation, was assessed with individual PSP slopes (rate of biomarker change per day), and the highest level. Pneumonia was diagnosed by clinical radiographic criteria and microbiological criteria. <b>Results:</b> Thirty-five patients out of 138 developed VAP. During the first 6 days, PSP was higher on days 3, 4, and 5 in patients who developed VAP (p&lt; 0.05). Median (1st-3rd qt) values of PSP at the day of VAP diagnosis were 144 ng/ml (79-440). The slope of PSP and the highest PSP concentration were not significantly associated with VAP (aOR 1.01, CI97,5%&nbsp;[0.98, 1.03]), (aOR 1, CI97,5% [0.99, 1] respectively) <b>Conclusion:</b> In this cohort of patients, the kinetics of PSP did not show predictive value for VAP diagnosis