RGD Reference Report - Plasminogen activation inhibitor concentrations in bronchoalveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients.

General

Plasminogen activation inhibitor concentrations in bronchoalveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients.
Authors:	Srinivasan, R Song, Y Wiener-Kronish, J Flori, HR
Citation:	Srinivasan R, etal., Pediatr Crit Care Med. 2010 May 13.
RGD ID:	4143511
Pubmed:	PMID:20473240 (View Abstract at PubMed)
DOI:	DOI:10.1097/PCC.0b013e3181e2a352 (Journal Full-text)
OBJECTIVE:: To compare the ability of four biomarkers to distinguish between those with ventilator-associated pneumonia (VAP) vs. lower respiratory tract bacterial colonization in mechanically ventilated intensive care unit (ICU) pediatric patients. DESIGN:: Prospective, pilot cohort study. SETTING:: Tertiary care children's hospital, pediatric ICU. PATIENTS:: All pediatric ICU patients mechanically ventilated >48 hrs were eligible for enrollment between April 2006 to May 2007. Thirty-three patients were consecutively screened and enrolled after institutional consent process. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: VAP was defined by both Centers for Disease and Prevention/National Nosocomial Infections Surveillance criteria and clinician diagnosis; those not meeting the criteria were considered to be colonized. Plasminogen activation inhibitor (PAI-1), soluble triggering receptor expressed on myeloid cells, receptor for advanced glycation end-products, and surfactant protein D levels were measured in bronchoalveolar lavage samples on average within 24 hrs of suspicion for VAP, i.e., a positive screening endotracheal Gram stain. Sixteen patients were diagnosed with VAP and 17 met the criteria for colonization. PAI-1 was associated with VAP independent of age, sex, race, acute lung injury/acute respiratory distress syndrome, Pediatric Risk of Mortality 3 score, pediatric logistic organ dysfunction score, and duration of intubation. The receiver operating characteristics for PAI-1 showed good discrimination with an area under the curve of 0.82. PAI-1 levels of >/=2.8 ng/mL had a sensitivity of 81.3%, specificity of 76.5%, and positive likelihood ratio of 3.5. Levels of soluble triggering receptor expressed on myeloid cells, receptor for advanced glycation end-products, and surfactant protein D were not significantly associated with VAP. CONCLUSIONS:: In mechanically ventilated pediatric ICU patients, PAI-1 is independently associated with the diagnosis of VAP. Real-time measurement of PAI-1 levels in bronchoalveolar lavage fluid may be of benefit in the early diagnosis and subsequent treatment of VAP in ICU patients.

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Term	Qualifier	Evidence	With	Reference	Notes	Source	Original Reference(s)
pneumonia		IEP		4143511	Pneumonia more ...	RGD
pneumonia		ISO	SERPINE1 (Homo sapiens)	4143511; 4143511	Pneumonia more ...	RGD

Objects Annotated

Genes (Rattus norvegicus)

Serpine1 (serpin family E member 1)

Genes (Mus musculus)

Serpine1 (serine (or cysteine) peptidase inhibitor, clade E, member 1)

Genes (Homo sapiens)

SERPINE1 (serpin family E member 1)

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Plasminogen activation inhibitor concentrations in bronchoalveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients.