Diagnostic Efficacy of Serum Amyloid A Protein and Soluble Intercellular Adhesion Molecule 1 in Pediatric Ventilator-Associated Pneumonia

• Published in: Journal of intensive care medicine 2019-06, Vol.34 (6), p.503-510
• Main Authors: Abo-Hagar, Hamdy H., Abo-Elezz, Ahmed Abd ElBasset, Mehrez, Mostafa, Mabrouk, Maaly M., Elshora, Ola A.
• Format: Article
• Language: English
• Subjects: Biomarkers - blood; Child; Child, Preschool; Egypt; Humans; Infant; Intensive Care Units; Intercellular Adhesion Molecule-1 - blood; Male; Pneumonia, Ventilator-Associated - blood; Pneumonia, Ventilator-Associated - physiopathology; Pneumonia, Ventilator-Associated - therapy; Predictive Value of Tests; Prognosis; Prospective Studies; Respiration, Artificial - adverse effects; Serum Amyloid A Protein - metabolism
• ISSN: 0885-0666; 1525-1489
• DOI: 10.1177/0885066617702598

Objectives: Study of inflammatory biomarkers which may aid in early detection of ventilator-associated pneumonia (VAP) in children and predicting their outcome. Patients: Thirty-five children, aged 2 months to 13 years, needed mechanical ventilation (MV) for more than 48 hours due to causes other than pneumonia. Methods: Measurement of serum amyloid A (SAA) protein, soluble intercellular adhesion molecule 1 (sICAM-1), and C-reactive protein (CRP), modified clinical pulmonary infection score (CPIS) and performing culture of endotracheal aspirate at the start and on the third day of MV. Results: Ventilator-associated pneumonia was diagnosed by CPIS in 6 (17.1%) of 35 patients. On the third day of MV, there was a significant increase in serum mean levels of SAA, sICAM-1, and CRP in comparison to the start of MV (P = .005, .004, and .01, respectively). Three (50%) of 6 patients with VAP died, while 4 (14.28%) of 28 patients without VAP died. The sensitivity of serum SAA, sICAM-1, and CPIS were 100% for predicting VAP, while specificity was highest for CPIS (96.55%) followed by SAA (93.1%). Combination of CPIS and SAA increased the specificity to 100%. For predicting nonsurvival, serum SAA and sICAM-1 had a sensitivity of 100% and a specificity of 92.86% and 89.29%, respectively. Conclusion: Serum amyloid A and sICAM-1 may be considered as reliable markers for detection of VAP. Combination of serum SAA with CPIS increased the specificity to 100%. Measurement of SAA in patients with VAP also had a good predictive value for nonsurvival in such patients.