APACHE II was 20.5 ± 6.7, initial SOFA was 8.8 ± 3.7, SOFA at VAP was 9.4 ± 3.1, CPIS 2 days before VAP was 4.6 ± 2, CPIS the day before VAP was 6 ± 1.2, and CPIS at VAP was 7.6 ± 1.3.
All patients admitted to our ICU's between January 2010 and December 2014 were included with the following criteria (1) mechanical ventilation for more than 48 h; (2) quantitatively significant culture of lower airways; (3) CPIS > 6.
Receiver operating characteristic (ROC) curves were constructed to illustrate the various cutoff values of sTREM-1, CPIS, and neutrophil count in BAL fluid.
BAL, bronchoalveolar lavage; sTREM-1, soluble triggering receptor expressed on myeloid cells-1; CPIS, Clinical Pulmonary Infection Score; CI, confidence interval.
(3) CPIS is not a reliable early indicator of pneumonia in patients with AWA.
Seventy-four episodes were excluded because of missing data (n = 22), inclusion in a RCT comparing atorvastatin to placebo for the management of VAP (n = 52), CPIS less than five or the absence of antibiotics delivered on day 1 (n = 208).
The mean CPIS values for MITT patients in both treatment arms for study Days 1 through 11 is shown in Figure 3. CPIS scores were similar for patients in the doripenem arm and the imipenem-cilastatin arm for the first eight days of the study.
Patients with severe complications had a mean 10-day CPIS value of 5.3, 7.1, 8.1 and 8.4 for patients with single organ failure (survival rate 100%), for patients with pulmonary contusion (survival rate 65%), for patients with severe sepsis (survival rate 26%) and for patients with multiple organ failure syndrome (>2 organs involved, survival rate 17%), respectively.
(2) Through CPIS <6 and negative SQTA performed in the first 48 hours we could identify that in more than one-half of AWA patients antibiotics are not needed.
We could not correlate decreasing ΔCPIS with adequacy of antibiotic treatment (p = 1.00) and CPIS < 6 on D3 with adequacy of treatment (p = 0.55).
