ABSTRACT Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results:There was a highly statistically significant difference (p value <0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p <0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p < 0.01) between mortality prediction scores (APACHE II (R=0.449), CRIP (R=0.403) and SOFA (R=0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.
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A. Halim, A. Attia, T. Zytoun and H. Salah, "The Diagnostic and Prognostic Value of Serum Procalcitonin among Ventilator Associated Pneumonia Patients*," Open Journal of Respiratory Diseases, Vol. 3 No. 2, 2013, pp. 73-78. doi: 10.4236/ojrd.2013.32012.
 W. G. Melsen, M. M. Rovers and M. J. Bonten, “Ventilator-Associated Pneumonia and Mortality: A Systematic Review of Observational Studies,” Critical Care Medicine, Vol. 37, No. 10, 2009, pp. 2709-2718.
 D. Hunter, “Ventilator Associated Pneumonia,” British Medical Journal, Vol. 344, No. 7859, 2012, p. e3325.
 J. Chastre and J. Y. Fagon, “Ventilator-Associated Pneumonia,” American Journal of Respiratory and Critical Care Medicine, Vol. 165, No. 7, 2002, pp. 867-903.
 K. L. Dandona Becker, R. Snider and E. S. Nylen, “Procalcitonin in Sepsis and Systemic Inflammation: A Harmful Biomarker and a Therapeutic Target,” British Journal of Pharmacology, Vol. 159, No. 2, 2010, pp. 253-264.
 S. Gibot, M. C. Béné, R. Noel, F. Massin, J. Guy, A. Cravoisy, D. Barraud, M. De Carvalho Bittencourt, J. P. Quenot, P. E. Bollaert, G. Faure and P. E. Charles, “Combination Biomarkers to Diagnose Sepsis in the Critically Ill Patient,” American Journal of Respiratory and Critical Care Medicine, Vol. 186, No. 1, 2012, pp. 65-71.
 C. Balci, H. Sungurtekin, E. Gürses, U. Sungurtekin and B. Kaptanoglu, “Usefulness of Procalcitonin for Diagnosis of Sepsis in the Intensive Care Unit,” Critical Care, Vol. 7, No. 1, 2003, pp. 85-90. doi:10.1186/cc1843
 H. K. Wolf, J. K. Gunnewiek, Y. Berk, J. V. D. Ouweland and M. D. Metz, “Comparison of a New Procalcitonin Assay from Roche with the Established Method on the Brahms Kryptor,” Clinical Chemistry, Vol. 55, No. 5, 2009, pp. 1043-1044. doi:10.1373/clinchem.2008.117655
 A. Alvaro Rea-Neto1, N. C M. Youssef, F. Tuche, F. Brunkhorst, V. M. Ranieri, K. Reinhart and Y. Saker, “Diagnosis of Ventilator-Associated Pneumonia: A Systematic Review of the Literature,” Critical Care, Vol. 12, No. 2, 2008, p. R56. doi:10.1186/cc6877
 M. Valencia and A. Torres, “Ventilator-Associated Pneumonia,” Current Opinion in Critical Care, Vol. 15, No. 1, 2009, pp. 30-35. doi:10.1097/MCC.0b013e3283220e78
 J. Y. Lee, S. J. Hwang, J. W. Shim, H. L. Jung, M. S. Park, H. Y. Woo and J. Y. Shim, “Clinical Significance of Serum Procalcitonin in Patients with Community-Acquired Lobar Pneumonia,” Korean Journal of Laboratory Medicine, Vol. 30, No. 4, 2010, pp. 406-413.
 A. Polzin, M. Pletz, R. Erbes, M. Raffenberg, H. Mauch, S. Wagner, G. Arndt and H. Lode, “Procalcitonin as a Diagnostic Tool in Lower Respiratory Tract Infections and Tuberculosis,” European Respiratory Journal, Vol. 21, No. 6, 2003, pp. 939-943.
 B. Müller, S. Harbarth, D. Stolz, R. Bingisser, C. Mueller, J. Leuppi, C. Nusbaumer, M. Tamm and M. Christ-Crain, “Diagnostic and Prognostic Accuracy of Clinical and Laboratory Parameters in Community-Acquired Pneumonia,” BMC Infectious Diseases, Vol. 7, 2007, pp. 10-20.
 M. Bafadhel, T. W. Clark, C. Reid, M. J. Medina, S. Batham, M. R. Barer, K. G. Nicholson and C. E. Brightling, “Procalcitonin and C-Reactive Protein in Hospitalized Adult Patients with Community-Acquired Pneumonia or Exacerbation of Asthma or COPD,” Chest, Vol. 6, 2011, pp. 1410-1418. doi:10.1378/chest.10-1747
 R. Seligman, B. G. Seligman and P. J. Teixeira, “Comparing the Accuracy of Predictors of Mortality in Ventilator-Associated Pneumonia,” Jornal Brasileiro de Pneumologia, Vol. 37, No. 4, 2011, pp. 495-503.
 P. Schuetz, B. Müller, M. Christ-Crain, D. Stolz, M. Tamm, L. Bouadma, C. E. Luyt, M. Wolff, J. Chastre, F. Tubach, K. B. Kristoffersen, O. Burkhardt, T. Welte, S. Schroeder, V. Nobre, L. Wei, N. Bhatnagar, H. C. Bucher and M. Briel, “Procalcitonin to Initiate or Discontinue Antibiotics in Acute Respiratory Tract Infections,” Cochrane Database of Systematic Reviews, Vol. 9, 2012, Article ID: CD007498.
 D. N. Gilbert, “Procalcitonin as a Biomarker in Respiratory Tract Infection,” Clinical Infectious Diseases, Vol. 52, Suppl. 4, 2011, pp. S346-S350.
 B. Müller, J. C. White, E. S. Nylén, R. H. Snider, K. L. Becker and J. F. Habener, “Ubiquitous Expression of the Calcitonin-I Gene in Multiple Tissues in Response to Sepsis,” Journal of Clinical Endocrinology & Metabolism, Vol. 86, No. 1, 2001, pp. 396-404.
 P. Linscheid, D. Seboek, E. S. Nylen, I. Langer, M. Schlatter, K. L. Becker, U. Keller and B. Müller, “In Vitro and in Vivo Calcitonin I Gene Expression in Parenchymal Cells: A Novel Product of Human Adipose Tissue,” Endocrinology, Vol. 144, No. 12, 2003, pp. 5578-5584. doi:10.1210/en.2003-0854
 K. L. Becker, E. S. Nylén, J. C. White, B. Müller and R. H. Snider Jr, “Clinical Review 167: Procalcitonin and the Calcitonin Gene Family of Peptides in Inflammation, Infection, and Sepsis: A Journey from Calcitonin back to Its Precursors,” Journal of Clinical Endocrinology & Metabolism, Vol. 89, No. 4, 2004, pp. 1512-1525.
 C. A. Scirè, L. Cavagna, C. Perotti, E. Bruschi, R. Caporali and C. Montecucco, “Diagnostic Value of Procalcitonin Measurement in Febrile Patients with Systemic Autoimmune Diseases,” Clinical and Experimental Rheumatology, Vol. 24, No. 2, 2006, pp. 123-128.
 F. Duflo, R. Debon, G. Monneret, J. Bienvenu, D. Chassard and B. Allaouchiche, “Alveolar and Serum Procalcitonin: Diagnostic and Prognostic Value in Ventilator-Associated Pneumonia,” Anesthesiology, Vol. 96, No. 1, 2002, pp. 74-79. doi:10.1097/00000542-200201000-00018
 C. E. Luyt, V. Guérin, A. Combes, J. L. Trouillet, S. B. Ayed, M. Bernard, C. Gibert and J. Chastre, “Procalcitonin Kinetics as a Prognostic Marker of Ventilator-Associated Pneumonia,” American Journal of Respiratory and Critical Care Medicine, Vol. 171, No. 1, 2005, pp. 48-53. doi:10.1164/rccm.200406-746OC
 S. Harbarth, K. Holeckova, C. Froidevaux, D. Pittet, B. Ricou, G. E. Grau, L. Vadas and J. Pugin, “Geneva Sepsis Network Diagnostic Value of Procalcitonin, Interleukin-6, and Interleukin-8 in Critically Ill Patients Admitted with Suspected Sepsis,” American Journal of Respiratory and Critical Care Medicine, Vol. 164, No. 3, 2001, pp. 396-402. doi:10.1164/ajrccm.164.3.2009052
 J. U. Jensen, L. Heslet, T. H. Jensen, K. Espersen, P. Steffensen and M. Tvede, “Procalcitonin Increase in Early Identification of Critically Ill Patients at High Risk of Mortality,” Critical Care Medicine, Vol. 34, No. 10, 2006, pp. 2596-2602.
 F. Bloos, J. C. Marshall, R. P. Dellinger, J. L. Vincent, G. Gutierrez, E. Rivers, R. A. Balk, P. F. Laterre, D. C. Angus, K. Reinhart and F. M. Brunkhorst, “Multinational, Observational Study of Procalcitonin in ICU Patients with Pneumonia Requiring Mechanical Ventilation: A Multicenter Observational Study,” Critical Care, Vol. 15, No. 2, 2011, p. R88. doi:10.1186/cc10087
 M. Meisner, K. Tschaikowsky, T. Palmaers and J. Schmidt, “Comparison of Procalcitonin (PCT) and C-Reactive Protein (CRP) Plasma Concentrations at Different SOFA Scores during the Course of Sepsis and MODS,” Critical Care, Vol. 3, No. 1, 1999, pp. 45-50. doi:10.1186/cc306
 J. Schroder, K. H. Staubach, P. Zabel, F. Stüber and B. Kremer, “Procalcitonin as a Marker of Severity in Septic Shock. Langenbecks,” Archives of Surgery, Vol. 384, No. 1, 1999, pp. 33-38. doi:10.1007/s004230050170
 J. Hedlund and L. O. Hansson, “Procalcitonin and C-Reactive Protein Levels in Community-Acquired Pneumonia: Correlation with Etiology and Prognosis,” Infection, Vol. 28, No. 2, 2000, pp. 68-73.
 N. Boussekey, O. Leroy, H. Georges, P. Devos, T. d’Escrivan and B. Guery, “Diagnostic and Prognostic Values of Admission Procalcitonin Levels in Community-Acquired Pneumonia in an Intensive Care Unit,” Infection, Vol. 33, No. 4, 2005, pp. 257-263.