VALIDITY OF D4/D0 PLASMA PROCALCITONIN LEVELS RATIO AS A PREDICTOR FOR MORTALITY OF VENTILATION-ASSOCIATED PNEUMONIA PATIENTS

To evaluate plasma procalcitonin (PCT) levels estimated at time of (D0) and 4 days (D4) after diagnosis of Ventilator-associated pneumonia (VAP) as a predictor for mortality. Patients Methods: VAP was diagnosed when pneumonia occurred after 48 hours of mechanical ventilation. Patients were evaluated clinically using APACHE II score and septic status was graded according to Bone s criteria. Blood samples were obtained D0 and D4 for estimation of plasma PCT levels. Patients were categorized into: Survivors included patients discharged through or at the end of 28- days (Day 28) and Non-survivors. Clinical data and plasma PCT levels and D4/D0 ratio were analyzed as predictors for mortality. Results: The study included 40 patients, but 15 patients died with a mortality rate of 37.5%. Mean duration of mechanical ventilation prior to D0(day of VAP diagnosis) was 5±1.5 days; 29 patients developed early; while 11 patients developed late VAP. Mean D0 and D4 plasma PCT levels were significantly higher in total patients compared to control levels. Mean D4 plasma PCT levels were significantly higher in total studied patients and in patients categorized according to outcome compared to D0 levels and in non-survivors compared to survivors. Mean D0/D4 ratio of PCT plasma levels was significantly higher in non-survivors compared to survivors. ROC curve analysis defined D4/D0 plasma PCT ratio and severity of sepsis as the significant predictors for mortality, but the difference was more significant for D4/D0 ratio. Conclusion: VAP is associated with high mortality rate and estimated levels of plasma PCT were significantly higher in non-survivors despite of treatment compared to survivors. High D4/D0 ratio of plasma PCT levels was found to be highly specific predictor of mortality among VAP patients.