TY - JOUR
T1 - Diagnostic importance of pulmonary interleukin-1 beta and interleukin-8 in ventilator-associated pneumonia
AU - Conway-Morris, Andrew
AU - Kefala, Kallirroi
AU - Wilkinson, Thomas S.
AU - Moncayo-Nieto, Olga Lucia
AU - Dhaliwal, Kevin
AU - Farrell, Lesley
AU - Walsh, Timothy S.
AU - Mackenzie, Simon J.
AU - Swann, David G.
AU - Andrews, Peter J. D.
AU - Anderson, Niall
AU - Govan, John R. W.
AU - Laurenson, Ian F.
AU - Reid, Hamish
AU - Davidson, Donald J.
AU - Haslett, Christopher
AU - Sallenave, Jean-Michel
AU - Simpson, A. John
PY - 2010/3
Y1 - 2010/3
N2 - Background: Ventilator-associated pneumonia (VAP) is the most commonly fatal nosocomial infection. Clinical diagnosis of VAP remains notoriously inaccurate. The hypothesis was tested that significantly augmented inflammatory markers distinguish VAP from conditions closely mimicking VAP.
Methods: A prospective, observational cohort study was carried out in two university hospital intensive care units recruiting 73 patients with clinically suspected VAP, and a semi-urban primary care practice recruiting a reference group of 21 age-and sex-matched volunteers. Growth of pathogens at >10(4) colony-forming units (cfu)/ml of bronchoalveolar lavage fluid (BALF) distinguished VAP from "non-VAP". Inflammatory mediators were quantified in BALF and serum. Mediators showing significant differences between patients with and without VAP were analysed for diagnostic utility by receiver operator characteristic (ROC) curves.
Results: Seventy-two patients had recoverable lavaged-24% had VAP. BALF interleukin-1 beta (IL-1 beta), IL-8, granulocyte colony-stimulating factor and macrophage inflammatory protein-1 alpha were significantly higher in the VAP group (all p<0.005). Using a cut-off of 10 pg/ml, BALF IL-1 beta generated negative likelihood ratios for VAP of 0.09. In patients with BALF IL-1 beta < 10 pg/ml the post-test probability of VAP was 2.8%. Using a cut-off value for IL-8 of 2 ng/ml, the positive likelihood ratio was 5.03. There was no difference in cytokine levels between patients with sterile BALF and those with growth of < 10(4) cfu/ml.
Conclusions: BALF IL-1 beta and IL-8 are amongst the strongest markers yet identified for accurately demarcating VAP within the larger population of patients with suspected VAP. These findings have potential implications for reduction in unnecessary antibiotic use but require further validation in larger populations.
AB - Background: Ventilator-associated pneumonia (VAP) is the most commonly fatal nosocomial infection. Clinical diagnosis of VAP remains notoriously inaccurate. The hypothesis was tested that significantly augmented inflammatory markers distinguish VAP from conditions closely mimicking VAP.
Methods: A prospective, observational cohort study was carried out in two university hospital intensive care units recruiting 73 patients with clinically suspected VAP, and a semi-urban primary care practice recruiting a reference group of 21 age-and sex-matched volunteers. Growth of pathogens at >10(4) colony-forming units (cfu)/ml of bronchoalveolar lavage fluid (BALF) distinguished VAP from "non-VAP". Inflammatory mediators were quantified in BALF and serum. Mediators showing significant differences between patients with and without VAP were analysed for diagnostic utility by receiver operator characteristic (ROC) curves.
Results: Seventy-two patients had recoverable lavaged-24% had VAP. BALF interleukin-1 beta (IL-1 beta), IL-8, granulocyte colony-stimulating factor and macrophage inflammatory protein-1 alpha were significantly higher in the VAP group (all p<0.005). Using a cut-off of 10 pg/ml, BALF IL-1 beta generated negative likelihood ratios for VAP of 0.09. In patients with BALF IL-1 beta < 10 pg/ml the post-test probability of VAP was 2.8%. Using a cut-off value for IL-8 of 2 ng/ml, the positive likelihood ratio was 5.03. There was no difference in cytokine levels between patients with sterile BALF and those with growth of < 10(4) cfu/ml.
Conclusions: BALF IL-1 beta and IL-8 are amongst the strongest markers yet identified for accurately demarcating VAP within the larger population of patients with suspected VAP. These findings have potential implications for reduction in unnecessary antibiotic use but require further validation in larger populations.
UR - http://www.scopus.com/inward/record.url?scp=77949786701&partnerID=8YFLogxK
U2 - 10.1136/thx.2009.122291
DO - 10.1136/thx.2009.122291
M3 - Article
SN - 0040-6376
VL - 65
SP - 201
EP - 207
JO - Thorax
JF - Thorax
IS - 3
ER -