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Original Research: Critical Care |

Diagnosis of Ventilator-Associated PneumoniaScore for Ventilator-Associated Pneumonia Diagnosis: A Pilot, Exploratory Analysis of a New Score Based on Procalcitonin and Chest Echography

Giovanni Zagli, MD, PhD; Morena Cozzolino, MD; Alessandro Terreni, BSc; Tiziana Biagioli, PhD; Anna Lucia Caldini, BSc; Adriano Peris, MD
Author and Funding Information

From the Anesthesia and Intensive Care Unit of the Emergency Department (Drs Zagli, Cozzolino, and Peris) and Laboratory Department (Mr Terreni, Dr Biagioli, and Ms Caldini), Careggi University Hospital, Florence, Italy.

CORRESPONDENCE TO: Giovanni Zagli, MD, PhD, Careggi University Hospital, Largo Brambilla 3, 50139, Florence, Italy; e-mail: giovanni.zagli@unifi.it


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):1578-1585. doi:10.1378/chest.13-2922
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BACKGROUND:  To facilitate the clinical diagnosis of ventilator-associated pneumonia (VAP) in the ICU, the Clinical Pulmonary Infection Score (CPIS) has been proposed but has shown a low diagnostic performance in subsequent studies. We propose a new score based on procalcitonin level and chest echography with the aim of improving VAP diagnosis: the Chest Echography and Procalcitonin Pulmonary Infection Score (CEPPIS).

METHODS:  This retrospective pilot study recruited patients admitted to the Intensive Care Unit of the Emergency Department, Careggi University Hospital (Florence, Italy), from January 2009 to December 2011. Patients were retrospectively divided into a microbiologically confirmed VAP group or a control group based on diagnosis of VAP and positive tracheal aspirate culture.

RESULTS:  A total of 221 patients were included, with 113 in the microbiologically confirmed VAP group and 108 in the control group. A CEPPIS > 5 retrospectively fixed was significantly better in predicting VAP (OR, 23.78; sensitivity, 80.5%; specificity, 85.2%) than a CPIS > 6 (OR, 3.309; sensitivity, 39.8%; specificity, 83.3%). The receiver operating characteristic area under the curve analysis also showed a significantly higher diagnostic value for CEPPIS > 5 than CPIS > 6 (0.829 vs 0.616, respectively; P < .0001).

CONCLUSIONS:  In this pilot, exploratory analysis, CEPPIS is effective in predicting VAP. Prospective validation is needed to confirm the potential value of this score to facilitate VAP diagnosis.

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