الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
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t is the second most common HAI after blood stream infection in the pediatric age group, accounting for about 20% of all HAIs in the pediatric intensive care units (PICUs) and has a rate of 2.9- 21.6 per 1000 ventilator days.
VAP should be suspected in patients with a new or progressive pulmonary infiltrate on imaging PLUS supportive clinical findings of infection (e.g., fever, secretions, leukocytosis). The diagnosis is confirmed when lower respiratory tract sampling identifies pathogen.
To assess diagnostic and prognostic value of tracheal aspirate procalcitonin level in critically ill pediatric patients with VAP.
This prospective cohort study was conducted on 50 ventilated patients collected from Pediatric Intensive Care Unit, Ain Shams University Children’s hospital in a period of 6 months starting from June 2023 till December 2023; they were divided into two groups VAP group and non VAP group. They were 26 females (52.0%) and 24 males (48%) with age ranged from 0.17 – 7 years and with median (IQR) of 1.75 (0.56 – 3).
On the first day of the study involving 50 patients, procalcitonin levels indicated varying degrees of inflammation and infection, with a wide range from 72.3 to 2500.
The evaluation of procalcitonin levels at Day 3 in critically ill pediatric patients with (VAP) compared to those without VAP (Non-VAP) revealed noteworthy differences. In the VAP group, the median procalcitonin level at Day 3 was substantially elevated at 574.9 (IQR: 362 – 719), significantly higher than the Non-VAP group with a median of 280 (IQR: 192.9 – 555). This difference was statistically significant (p-value = 0.026), suggesting that procalcitonin levels may serve as a valuable biomarker for differentiating between VAP and non-VAP patients in this population. Additionally, procalcitonin levels at the onset of VAP in both bronchoalveolar lavage (BAL) and serum were notably elevated in the VAP group, with a median of 2500 (IQR: 1231 – 2500) and 2161 (IQR: 1084 – 2500), respectively, further emphasizing the potential diagnostic utility of procalcitonin in identifying VAP. These findings indicate that procalcitonin levels, particularly on Day 3, may have clinical relevance in the early diagnosis and monitoring of VAP in critically ill pediatric patients.
In the evaluation of procalcitonin levels on Day 3 as a diagnostic marker for (VAP) in critically ill pediatric patients, the calculated area under the curve (AUC) was 0.683, indicating a fair discriminatory capacity. When using a cutoff point of >255.4 ng/mL for procalcitonin on Day 3, the sensitivity was relatively high at 92.00%, suggesting that this cutoff effectively identified true positive cases of VAP. However, the specificity was lower at 48.00%, meaning that a significant number of non-VAP cases were also identified as positive. The positive predictive value (+PV) was 63.9%, indicating the probability of having VAP when the test is positive, and the negative predictive value (-PV) was 85.7%, showing the likelihood of not having VAP when the test is negative. These results suggest that while procalcitonin on Day 3 may be a useful tool for ruling out VAP due to its high negative predictive value.
The comparison between patients who were discharged and those who died revealed significant differences in procalcitonin levels at various time points. Specifically, the median procalcitonin level at day 3 was significantly lower in the discharged group (248.2, IQR: 189.7 – 453.4) compared to the group that died (574.9, IQR: 353.6 – 792), with a p-value of 0.003, indicating a strong association between higher procalcitonin levels at day 3 and an increased risk of mortality. Furthermore, when analyzing procalcitonin levels at the onset of (VAP), both procalcitonin level in bronchoalveolar lavage (BAL) and procalcitonin level in serum were significantly higher in the group that died compared to the discharged group. These findings suggest that procalcitonin levels, especially at day 3 and at the onset of VAP, can serve as valuable prognostic markers for predicting patient outcomes in this cohort, with higher levels being associated with an increased risk of mortality.
The analysis of various procalcitonin levels as diagnostic markers in critically ill pediatric patients with (VAP) revealed promising results. Procalcitonin levels at day 3 demonstrated a good diagnostic performance, with an area under the curve (AUC) of 0.756, indicating its ability to discriminate between VAP and non-VAP cases. It showed relatively high sensitivity (84.85%) and reasonable specificity (64.71%), making it a valuable tool for identifying VAP in this population. Moreover, procalcitonin levels in bronchoalveolar lavage (BAL) at the onset of VAP exhibited an even better diagnostic performance, with an AUC of 0.821, perfect sensitivity (100.00%), and good specificity (75.00%), making it an excellent marker for confirming the presence of VAP. Lastly, procalcitonin levels in serum at the onset of VAP demonstrated exceptional diagnostic capability, with an AUC of 0.940, high sensitivity (90.48%), and perfect specificity (100.00%), suggesting it as an ideal marker for both confirming the diagnosis of VAP and ruling out non-VAP cases in critically ill pediatric patients. These findings highlight the clinical utility of procalcitonin levels, especially in BAL and serum, as valuable diagnostic tools for VAP in this patient population.
CONCLUSION
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n conclusion, this study underscores the significant diagnostic and prognostic value of procalcitonin levels in critically ill pediatric patients with (VAP). Procalcitonin levels, especially at day 3, demonstrated good diagnostic performance in differentiating between VAP and non-VAP cases. Additionally, procalcitonin levels in bronchoalveolar lavage (BAL) and serum at the onset of VAP emerged as highly reliable markers for confirming the presence of VAP, with excellent sensitivity and specificity. These findings highlight the potential for procalcitonin to aid in the early diagnosis and management of VAP in this vulnerable patient population, ultimately contributing to improved clinical outcomes and patient care in intensive care settings, there is no difference between procalcitonin level in BAL and serum.
RECOMMENDATIONS
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ased on the findings of this study, it is recommended that procalcitonin levels, in bronchoalveolar lavage (BAL) and serum, be integrated into the diagnostic and clinical management protocols for critically ill pediatric patients with (VAP).
Procalcitonin levels at day 3 can serve as a valuable screening tool with good sensitivity and specificity for identifying VAP cases. Moreover, procalcitonin levels in BAL at the onset of VAP demonstrated excellent diagnostic performance, making it a robust confirmatory marker. Additionally, procalcitonin levels in serum at the onset of VAP exhibited exceptional diagnostic capability.