Background
Ventilator-associated pneumonia (VAP) is the most common hospital-acquired, life-threatening
infection. Poor outcome and health-care costs of nosocomial pneumonia remain a global
burden. Currently, physicians rely on their experience to discriminate patients with
good and poor outcome. However, standardized prognostic measures might guide medical
decisions in the future. Pancreatic stone protein (PSP)/regenerating protein (reg)
is associated with inflammation, infection, and other disease-related stimuli. The
prognostic value of PSP/reg among critically ill patients is unknown. The aim of this
pilot study was to evaluate PSP/reg in VAP.
Methods
One hundred one patients with clinically diagnosed VAP were assessed. PSP/reg was
retrospectively analyzed using deep-frozen serum samples from VAP onset up to day
7. The main end point was death within 28 days after VAP onset.
Results
Serum PSP/reg was associated with the sequential organ failure assessment score from
VAP onset (Spearman rank correlation coefficient 0.49
P < .001) up to day 7. PSP/reg levels at VAP onset were elevated in nonsurvivors (n
= 20) as compared with survivors (117.0 ng/mL [36.1-295.3] vs 36.3 ng/mL [21.0-124.0]
P = .011). The areas under the receiver operating characteristic curves of PSP/reg
to predict mortality/survival were 0.69 at VAP onset and 0.76 at day 7. Two PSP/reg
cutoffs potentially allow for identification of individuals with a particularly good
and poor outcome. Whereas PSP/reg levels below 24 ng/mL at VAP onset were associated
with a good chance of survival, levels above 177 ng/mL at day 7 were present in patients
with a very poor outcome.
Conclusions
Serum PSP/reg is a biomarker related to organ failure and outcome in patients with
VAP.
Trial registry
ISRCTN.org; No.: ISRCTN61015974; URL:
www.isrctn.org.
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Article Info
Publication History
Accepted:
June 20,
2011
Received:
January 4,
2011
Footnotes
Funding/Support: Dr Stolz was supported by grants from the Swiss National Foundation [ PP00P3_128412/1 ], the Liechtenstein Foundation, and the “Freiwillige Akademische Gesellschaft Basel.” Dr Thakkar was supported by the Will Rogers Foundation. Additional funding was granted by the Clinic of Pulmonary Medicine, University Hospital Basel, Basel, Switzerland.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
Identification
Copyright
© 2011 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
