Procalcitonin Predicts Recurrence or Death After Ventilator-Associated Pneumonia

Elevated serum procalcitonin levels at end of treatment predict increased risk for 30-day mortality and infection recurrence in patients with ventilator-associated pneumonia (VAP), according to study results presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

Researchers in the United States at the University of Michigan in Ann Arbor conducted a retrospective, single-center, cohort study between 2013 and 2022. They analyzed the relationship between serum procalcitonin levels and risk of 30-day mortality and infection recurrence in 140 patients hospitalized with VAP.

VAP was defined as the onset of pneumonia infection as confirmed with positive laboratory cultures following 2 or more days on mechanical ventilation in addition to 5 or more days of antibiotic treatment to resolve the pneumonia.

Among 140 patients included in the analysis, 56.4% had serum procalcitonin levels of less than 0.5 ng/mL, while 43.6% had levels of 0.5 ng/mL or higher. Of patients with and without elevated serum procalcitonin levels, the mean age was 55.3 and 55.3 years, 57.4%% and 63.3% were men, 29.5% and 44.3% had cerebrovascular disease, 32.8% and 27.6% were immunocompromised, and 54.1% and 20.3% had kidney disease, respectively.

Patients with elevated serum procalcitonin levels stayed in the hospital (10 vs 5 days, respectively; P =.004) and received antibiotic treatment longer (10 vs 8 days, respectively; P =.004) than those with nonelevated levels.

In the multivariable analysis, elevated serum procalcitonin levels correlated with increased risk of death or recurrence of pneumonia within 30 days after completion of antibiotic treatment compared with nonelevated levels (adjusted odds ratio, 2.37; 95% CI, 1.09-5.17).

“Elevated EOT-P [end-of-treatment procalcitonin] in VAP was independently associated with increased VAP recurrence or mortality within 30 days,” the authors wrote. “Use of end-of-treatment procalcitonin in VAP may serve as a candidate biomarker to predict VAP recurrence and death.”