RT Journal Article
SR Electronic
T1 Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 41
OP 47
DO 10.1136/thoraxjnl-2014-205766
VO 70
IS 1
A1 Thomas P Hellyer
A1 Andrew Conway Morris
A1 Daniel F McAuley
A1 Timothy S Walsh
A1 Niall H Anderson
A1 Suveer Singh
A1 Paul Dark
A1 Alistair I Roy
A1 Simon V Baudouin
A1 Stephen E Wright
A1 Gavin D Perkins
A1 Kallirroi Kefala
A1 Melinda Jeffels
A1 Ronan McMullan
A1 Cecilia M O'Kane
A1 Craig Spencer
A1 Shondipon Laha
A1 Nicole Robin
A1 Savita Gossain
A1 Kate Gould
A1 Marie-Hélène Ruchaud-Sparagano
A1 Jonathan Scott
A1 Emma M Browne
A1 James G MacFarlane
A1 Sarah Wiscombe
A1 John D Widdrington
A1 Ian Dimmick
A1 Ian F Laurenson
A1 Frans Nauwelaers
A1 A John Simpson
YR 2015
UL http://thorax.bmj.com/content/70/1/41.abstract
AB Background Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare.Objectives We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP.Methods A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >104 colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination.Results Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p<0.001). The area under the receiver operator characteristic curve for IL-1β was 0.81; IL-8, 0.74; MMP-8, 0.76; MMP-9, 0.79 and HNE, 0.78. A combination of IL-1β and IL-8, at the optimal cut-point, excluded VAP with a sensitivity of 100%, a specificity of 44.3% and a post-test probability of 0% (95% CI 0% to 9.2%).Conclusions Low BALF IL-1β in combination with IL-8 confidently excludes VAP and could form a rapid biomarker-based rule-out test, with the potential to improve antibiotic stewardship.