Role of C-reactive Protein and Tumor Necrosis Factor-Alpha in Differentiating between Ventilator-Associated Pneumonia and Systemic Inflammatory Response Syndrome without Infectious Etiology

Salehifar, Ebrahim; Arjmand, Shima Tavakolian; Aliyali, Masoud; Abedi, Siavash; Sharifpour, Ali; Alipour, Abbas; Ala, Shahram; Eslami, Gohar; Bozorgi, Farzad; Mahdavi, Mohammad Reza; R. Walley, Keith

Role of C-reactive Protein and Tumor Necrosis Factor-Alpha in Differentiating between Ventilator-Associated Pneumonia and Systemic Inflammatory Response Syndrome without Infectious Etiology

Authors

Ebrahim Salehifar ¹

Shima Tavakolian Arjmand ¹

Masoud Aliyali ²

Siavash Abedi ²

Ali Sharifpour ²

Abbas Alipour ³

Shahram Ala ¹

Gohar Eslami ¹

Farzad Bozorgi ⁴

Mohammad Reza Mahdavi ⁵

Keith R. Walley ⁶

¹ Department of Pharmacotherapy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran,

² Department of Internal Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,

³ Department of Epidemiology and Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,

⁴ Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,

⁵ Department of Laboratory Tests, Mazandaran University of Medical Sciences, Sari, Iran,

⁶ Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada

Abstract

Background: Differential diagnosis of systemic inflammatory response syndrome (SIRS) with or without infectious cause is critically important in terms of initiating antimicrobial agents in case of infectious etiology such as ventilator-associated pneumonia (VAP). The aim of this study was to determine the diagnostic and prognostic roles of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) in differentiating between ventilator-associated pneumonia and SIRS without infectious etiology. Materials and Methods: In this prospective observational study, 91 adult intensive care unit (ICU) patients were enrolled. According to established diagnostic criteria, they were classified into three groups of “non-SIRS nonVAP”, “SIRS non-VAP” and “SIRS-VAP”. Serum CRP and TNF-α were measured on days 1, 3 and 7 of the study and compared using repeated measures ANOVA. Results: With respect to diagnosis, there was no significant difference in the values of these biomarkers between groups (P>0.05). There was no statistically significant “time trend” for C-reactive protein and TNF-α (P>0.05). Considering both group effect and Time effect, the changes were not significantly different for CRP (P= 0.86) and TNF-α (P=0.69). In contrast, the clinical score and the clinical pulmonary infection score (CPIS)  6, had 100% specificity for diagnosing VAP. With respect to prognosis, only an unchanged or decreasing TNF-α from day 1 to day 3 was marginally associated with 28- day survival. However, day 1 and day 3 acute physiology and chronic health evaluation II (APACHE II) scores were highly associated with 28-day survival. Conclusion: Unlike clinical scoring system including CPIS and APACHE II, TNF-α and CRP levels were not useful as diagnostic or prognostic biomarkers for differentiating between SIRS with VAP etiology and SIRS without infectious etiology.

Keywords

Biomarker

Infection

Inflammation

Systemic inflammatory response syndrome

Ventilator-Associated Pneumonia