The role of clinical pulmonary infection score and some infection biomarkers in diagnosis and follow up in hospital acquired pneumonia

Abstract

Aims: Early diagnosis and treatment affect mortality in hospital-acquired pneumonia (HAP). Therefore, clinicians need some objective parameters for guiding treatment. The aim of this study was to determine the course of ‘‘clinical pulmonary infection score’’ (CPIS), C-reactive protein (CRP) and procalcitonin (PCT) in patients under treatment as well as the relationship of these parameters with each other and mortality. Methods: This single-center, prospective, cross-sectional study focused on cases of HAP in hospitalized patients. In patients with HAP; CPIS, CRP and PCT assays were assessed on the first day. Appropriate treatment was initiated according to Turkish Thoracic Society HAP Task Force recommendations. On the 3rd day, CPIS evaluation and on the 4th day CRP and PCT analysis were repeated. All the patients’ one month mortality rates were recorded. Results: Among the 25 patients, there were 14 females. The mean age was 66±15 years. The mean duration for HAP development was 9.4±8.2 days. With a cutt-off value of 65 for age CPIS, CRP, PCT, length of hospital stay and mortality rate was not found different (p>0.05), however as the age increased HAP development duration significantly decreased (r=-0.416, p=0.03). We demonstrated a significant change between the first and the follow-up values of fever (p=0.046), leukocyte (p<0.001), PaO2/FiO2 (p=0.016), secretion presence (p<0.001), culture positivity (p<0.001) as well as total CPIS (p=0.030). However, there wasn’t a significant difference in CRP and PCT levels. We couldn’t show any relation between CPIS domains, total CPIS, CRP, PCT, HAP development duration and mortality rates. Conclusion: Monitoring HAP treatment according to CPIS was found better than CRP and PCT. However, these parameters had no effect on mortality. For more accurate comments, studies with more patients are needed.