Alveolar pentraxin 3 as an early marker of microbiologically confirmed pneumonia: a threshold-finding prospective observational study

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• 作者：Tommaso Mauri (1) (2)
  Andrea Coppadoro (1) (2)
  Michela Bombino (2)
  Giacomo Bellani (1) (2)
  Vanessa Zambelli (1)
  Carla Fornari (3)
  Lorenzo Berra (4)
  Edward A Bittner (4)
  Ulrich Schmidt (4)
  Marina Sironi (5)
  Barbara Bottazzi (5)
  Paolo Brambilla (1)
  Alberto Mantovani (5) (6)
  Antonio Pesenti (1) (2)
  
  1. Department of Health Science ; University of Milan-Bicocca ; Via Cadore 48 ; 20900 ; Monza ; Italy
  2. Department of Emergency Medicine ; San Gerardo Hospital ; Via Pergolesi 33 ; 20900 ; Monza ; Italy
  3. Research Centre on Public Health ; Department of Statistics and Quantitative Methods ; University of Milan-Bicocca ; Via Pergolesi 33 ; 20900 ; Monza ; Italy
  4. Department of Anesthesia ; Critical Care ; and Pain Medicine ; Massachusetts General Hospital and Harvard Medical School ; 55 Fruit St ; 02114 ; Boston ; MA ; USA
  5. Department of Inflammation and Immunology ; Humanitas Clinical and Research Center ; Via Manzoni 56 ; 20089 ; Rozzano ; MI ; Italy
  6. Department of Translational Medicine ; University of Milan ; Via Festa del Perdono 7 ; 20122 ; Rozzano ; MI ; Italy
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：18
• 期：5
• 全文大小：599 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Timely diagnosis of pneumonia in intubated critically ill patients is rather challenging. Pentraxin 3 (PTX3) is an acute-phase mediator produced by various cell types in the lungs. Animal studies have shown that, during pneumonia, PTX3 participates in fine-tuning of inflammation (for example, microbial clearance and recruitment of neutrophils). We previously described an association between alveolar PTX3 and lung infection in a small group of intubated patients. The aim of the present study was to determine a threshold level of alveolar PTX3 with elevated sensitivity and specificity for microbiologically confirmed pneumonia. Methods We recruited 82 intubated patients from two intensive care units (San Gerardo Hospital, Monza, Italy, and Massachusetts General Hospital, Boston, MA, USA) undergoing bronchoalveolar lavage (BAL) as per clinical decision. We collected BAL fluid and plasma samples, together with relevant clinical and microbiological data. We assayed PTX3 and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in BAL fluid and PTX3, sTREM-1, C-reactive protein (CRP) and procalcitonin (PCT) in plasma. Two blinded independent physicians reviewed patient data to confirm pneumonia. We determined the PTX3 threshold in BAL fluid for pneumonia and compared it to other biomarkers. Results Microbiologically confirmed pneumonia of bacterial (n =12), viral (n =4) or fungal (n =8) etiology was diagnosed in 24 patients (29%). PTX3 levels in BAL fluid predicted pneumonia with an area under the receiving operator curve of 0.815 (95% CI =0.710 to 0.921, P P Conclusions In this hypothesis-generating convenience sample, a PTX3 level 鈮?聽ng/ml in BAL fluid was discriminative of microbiologically confirmed pneumonia in mechanically ventilated patients.