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Original Research: CRITICAL CARE |

Pancreatic Stone ProteinPancreatic Stone Protein: A Marker of Organ Failure and Outcome in Ventilator-Associated Pneumonia

Lucas Boeck, MD; Rolf Graf, MD; Philippe Eggimann, MD; Hans Pargger, MD; Dimitri A. Raptis, MD; Nicholas Smyrnios, MD; Nehal Thakkar, MD; Martin Siegemund, MD; Janko Rakic, MD; Michael Tamm, MD, FCCP; Daiana Stolz, MD, MPH
Author and Funding Information

From the Clinic of Pulmonary Medicine and Respiratory Cell Research (Drs Boeck, Rakic, Tamm, and Stolz) and the Department of Anesthesiology and Surgical Intensive Care Medicine (Drs Pargger and Siegemund), University Hospital Basel, Basel, Switzerland; the Department of Visceral and Transplantation Surgery (Drs Graf and Raptis), University Hospital Zürich, Zürich, Switzerland; the Department of Adult Critical Care Medicine (Dr Eggimann), University Hospital Lausanne, Lausanne, Switzerland; and the Division of Pulmonary, Allergy and Critical Care Medicine (Drs Smyrnios and Thakkar), UMass Memorial Medical Center, Worcester, MA.

Correspondence to: Daiana Stolz, MD, MPH, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland; e-mail: dstolz@uhbs.ch


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).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):925-932. doi:10.1378/chest.11-0018
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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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