C-Reactive Protein Kinetics in Prognosis
of Ventilator Associated Pneumonia
Published: August 1, 2020 | DOI: https://doi.org/10.7860/JCDR/2020/44720.13959
Chandan Kumar Shit, Sudarsan Pothal, Aurobindo Behera, Rekha Manjhi, Pravati Dutta, Gourahari Pradhan
1. Consultant, Department of Pulmonary Medicine, Calcutta Heart Clinic and Hospital, Kolkata, West Bengal, India.
2. Associate Professor, Department of Pulmonary Medicine, V.S.S. Institute of Medical Sciences and Research, Burla, Odisha, India.
3. Assistant Professor, Department of Pulmonary Medicine, V.S.S. Institute of Medical Sciences and Research, Burla, Odisha, India.
4. Associate Professor, Department of Pulmonary Medicine, V.S.S. Institute of Medical Sciences and Research, Burla, Odisha, India.
5. Professor, Department of Pulmonary Medicine, V.S.S. Institute of Medical Sciences and Research, Burla, Odisha, India.
6. Assistant Professor, Department of Pulmonary Medicine, V.S.S. Institute of Medical Sciences and Research, Burla, Odisha, India.
Correspondence
Sudarsan Pothal,
Associate Professor, Department of Pulmonary Medicine, V.S.S. Institute of Medical Sciences and Research, Burla, Odisha, India.
E-mail: pothal2002@yahoo.co.in
Introduction: Prognosis of Ventilator Associated Pneumonia (VAP) is commonly predicted by on-site assessment of clinical, haematological and biochemical parameters. Sequential measurement of C-Reactive Protein (CRP) which is one of the low-cost biomarkers could be useful in the early identification of poor outcome of VAP.
Aim: To assess the prognostic value of progressive CRP levels in patients with VAP and compare with non-VAP group of ventilated patients.
Materials and Methods: This was a prospective observational cohort study at medico-surgical ICU between November 2017 and October 2018. The patients on mechanical ventilator for more than 48 hours were divided into VAP (n=27) and non-VAP group (n=38). VAP was considered based on modified Clinical Pulmonary Infection Score (CPIS) more than 6 along with microbiological evidence from Tracheal aspirate or Bronchoalveolar lavage fluid with consolidation in Chest X-ray. Study subjects were monitored for the development of VAP. CRP measurements were done daily for the first 7 days then on 14th day. The evolution of mean CRP concentration throughout the course of VAP and non-VAP were analysed and compared between survivors and non-survivors.
Results: Mean CRP level of VAP patients on the day of diagnosis was almost similar to non-VAP cohort. The mean CRP of non-survivor groups of both VAP and non-VAP patients had shown a gradual increase after day 4. However, the mean CRP after day 4, in the survivor group of both VAP and non-VAP showed either decreasing or unchanged trends.
Conclusion: It was evident that the dynamics of the CRP levels in patients with VAP can be used to assess the effects of the therapy for a better outcome.
[
FULL TEXT ] | [ PDF]