Edinburgh Research Explorer

Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia

Research output: Contribution to journalArticle

  • Thomas P. Hellyer
  • Daniel F. McAuley
  • Suveer Singh
  • Paul Dark
  • Alistair I. Roy
  • Simon V. Baudouin
  • Stephen E. Wright
  • Gavin D. Perkins
  • Kallirroi Kefala
  • Melinda Jeffels
  • Ronan McMullan
  • Cecilia M. O'Kane
  • Craig Spencer
  • Shondipon Laha
  • Nicole Robin
  • Savita Gossain
  • Kate Gould
  • Marie-Helene Ruchaud-Sparagano
  • Jonathan Scott
  • Emma M. Browne
  • James G. MacFarlane
  • Sarah Wiscombe
  • John D. Widdrington
  • Ian Dimmick
  • Ian F. Laurenson
  • Frans Nauwelaers
  • A. John Simpson

Related Edinburgh Organisations

Original languageEnglish
Pages (from-to)41-47
Number of pages7
JournalThorax
Volume70
Issue number1
Early online date8 Oct 2014
DOIs
Publication statusPublished - Jan 2015

Abstract

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 >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1 beta), 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

Conclusions Low BALF IL-1 beta 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.

    Research areas

  • BRONCHOALVEOLAR LAVAGE FLUID, PROGNOSTIC VALUE, BRONCHOPNEUMONIA, PROCALCITONIN, INFECTION, OUTCOMES, PROTEIN, MARKER, LUNG

ID: 19314856