PREDICTION OF CLINICAL SEVERITY AND OUTCOME OF VENTILATOR-ASSOCIATED PNEUMONIA - COMPARISON OF SIMPLIFIED ACUTE PHYSIOLOGY SCORE WITH SYSTEMIC INFLAMMATORY MEDIATORS

Systemic kinetics of three inflammatory mediators (bactericidal/permea bility-increasing protein [BPI], soluble intercellular adhesion molecu le [sICAM], and soluble E-selectin [sE-selectin]) were studied during the development of ventilator-associated pneumonia (VAP) (n = 42), dia gnosed on quantitative cultures of bronchoscopic samples. From a pool of collected samples, nested samples were used to measure mediators on Days -4 -2, 0, and +2, relative to diagnosis. Correlations between sy stemic levels of mediators and clinical severity of infection (VAP wit h or without severe sepsis or septic shock) and patient outcome (morta lity at Day 10 after diagnosis) were studied. Predictive values of inf lammatory mediators were compared with daily Simplified Acute Physiolo gy Score II (SAPS II) values and the logarithmic number of bacteria in bronchoscopic samples. During the development of VAP, increasing SAPS II scores and rising systemic mediator levels were only found in pati ents in whom VAP was accompanied with severe sepsis or septic shock. V alues of SAPS II and plasma levels of BPI and sE-selectin, but not sIC AM, increased from the day of diagnosis on in patients who died within 10 d of diagnosis. Systemic levels of inflammatory mediators did not better predict clinical severity or patient outcome than daily SAPS II scores. The logarithmic number of bacteria in bronchoscopic samples p oorly correlated with circulating levels of inflammatory mediators, se verity of infection, and patient outcome. Our findings show that a cli nical scoring system (SAPS II score) is at least as good as a predicto r for the clinical severity of infection and patient outcome, and prov ide new information on the kinetics of inflammatory mediators during t he development of VAP.