Biomarkers kinetics in the assessment of ventilator-associated pneumonia response to antibiotics - results from the BioVAP study

P. Póvoa, I. Martin-Loeches, P. Ramirez, L.D. Bos, M. Esperatti, J. Silvestre, G. Gili, G. Goma, E. Berlanga, M. Espasa, E. Gonçalves, A. Torres, A. Artigas

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14 Citations (Scopus)

Abstract

Purpose Our aim was to evaluate the role of biomarker kinetics in the assessment of ventilator-associated pneumonia (VAP) response to antibiotics. Materials and methods We performed a prospective, multicenter, observational study to evaluate in 37 microbiologically documented VAP, the kinetics of C-reactive protein (CRP), procalcitonin (PCT), mid-region fragment of pro-adrenomedullin (MR-proADM). The kinetics of each variable, from day 1 to 6 of therapy, was assessed with a time dependent analysis comparing survivors and non-survivors. Results During the study period kinetics of CRP as well as its relative changes, CRP-ratio, was significantly different between survivors and non-survivors (p = 0.026 and p = 0.005, respectively). On day 4 of antibiotic therapy, CRP of survivors was 47% of the initial value while it was 96% in non-survivors. The kinetics of other studied variables did not distinguish between survivors and non-survivors. In survivors the bacterial load also decreased markedly. Adequate initial antibiotic therapy was associated with lower mortality (p = 0.025) and faster CRP decrease (p = 0.029). Conclusions C-reactive protein kinetics can be used to identify VAP patients with poor outcome as soon as four days after the initiation of treatment. (Trial registration - NCT02078999; registered 3 August 2012). © 2017 Elsevier Inc.
Original languageEnglish
Pages (from-to)91-97
Number of pages7
JournalJournal Of Critical Care
Volume41
DOIs
Publication statusPublished - 1 Oct 2017

Keywords

  • C-reactive protein
  • Mid-region fragment of pro-adrenomedullin
  • Procalcitonin
  • Prognosis
  • Ventilator-associated pneumonia
  • antibiotic agent
  • biological marker
  • C reactive protein
  • proadrenomedullin
  • procalcitonin
  • adult
  • antibiotic therapy
  • Article
  • bacterial infection
  • bacterial load
  • clinical article
  • clinical assessment
  • clinical effectiveness
  • clinical evaluation
  • disease association
  • drug efficacy
  • drug response
  • female
  • human
  • male
  • mortality
  • multicenter study
  • observational study
  • protein blood level
  • survivor
  • ventilator associated pneumonia

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