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A new scoring system for early diagnosis of ventilator-associated pneumonia: LUPPIS.
Archives of Medical Science ( IF 3.0 ) Pub Date : 2020-08-10 , DOI: 10.5114/aoms.2020.97965 Murat Haliloglu 1 , Beliz Bilgili 1 , Huseyin Bilginer 2 , Umut Sabri Kasapoglu 1 , Ismet Sayan 1 , Melek Suzer Aslan 1 , Lutfiye Mulazimoglu Durmusoglu 2 , Ismail Cinel 1
Archives of Medical Science ( IF 3.0 ) Pub Date : 2020-08-10 , DOI: 10.5114/aoms.2020.97965 Murat Haliloglu 1 , Beliz Bilgili 1 , Huseyin Bilginer 2 , Umut Sabri Kasapoglu 1 , Ismet Sayan 1 , Melek Suzer Aslan 1 , Lutfiye Mulazimoglu Durmusoglu 2 , Ismail Cinel 1
Affiliation
Introduction
The Clinical Pulmonary Infection Score (CPIS) based on chest X-ray has been developed to facilitate clinical diagnosis of ventilator-associated pneumonia (VAP); however, this scoring system has a low diagnostic performance. We developed the Lung Ultrasound and Pentraxin-3 Pulmonary Infection Score (LUPPIS) for early diagnosis of VAP and evaluated the performance of this new scoring system.
Material and methods
In a prospective study of 78 patients with suspected VAP, we assessed the detection accuracy of LUPPIS for pneumonia in adult patients. We also evaluated the diagnostic performance of pentraxin-3 (PTX-3) findings of infection. On the day of the study, lung ultrasound was performed, PTX-3 levels were determined, and an endotracheal aspirate was obtained for Gram staining and culture.
Results
No significant differences were found between groups with respect to age, mechanical ventilation time, APACHE II score, or SOFA score (p > 0.05). Procalcitonin and PTX-3 levels were significantly higher in the VAP (+) group (p < 0.001 and p < 0.001, respectively). The threshold for LUPPIS in differentiating VAP (+) patients from VAP (â) patients was > 7. In predicting VAP, LUPPIS > 7 (sensitivity of 84%, specificity of 87.7%) was superior to CPIS > 6 (sensitivity of 40.1%, specificity of 84.5%).
Conclusions
LUPPIS appears to provide better results in the prediction of VAP compared to CPIS, and the importance of lung ultrasound and PTX-3 is emphasized, which is a distinctive property of LUPPIS.
中文翻译：
呼吸机相关性肺炎早期诊断新评分系统：LUPPIS。
引言
基于胸部 X 线的临床肺部感染评分 (CPIS) 已被开发用于促进呼吸机相关性肺炎 (VAP) 的临床诊断；但是，该评分系统的诊断性能较低。我们开发了用于早期诊断 VAP 的肺超声和 Pentraxin-3 肺部感染评分 (LUPPIS)，并评估了这种新评分系统的性能。
材料与方法
在一项对 78 名疑似 VAP 患者的前瞻性研究中，我们评估了 LUPPIS 对成人患者肺炎的检测准确性。我们还评估了 pentraxin-3 (PTX-3) 感染发现的诊断性能。在研究当天，进行了肺部超声检查，测定了 PTX-3 水平，并获得了气管内吸出物用于革兰氏染色和培养。
结果
在年龄、机械通气时间、APACHE II 评分或 SOFA 评分方面，各组之间未发现显着差异（p > 0.05）。VAP (+) 组的降钙素原和 PTX-3 水平显着升高（分别为 p < 0.001 和 p < 0.001）。区分 VAP (+) 患者和 VAP (-) 患者的 LUPPIS 阈值 > 7。在预测 VAP 时，LUPPIS > 7（敏感性为 84%，特异性为 87.7%）优于 CPIS > 6（敏感性为40.1%，特异性 84.5%）。
结论
与 CPIS 相比，LUPPIS 在预测 VAP 方面似乎提供了更好的结果，并且强调了肺部超声和 PTX-3 的重要性，这是 LUPPIS 的一个独特特性。
更新日期：2020-08-20
The Clinical Pulmonary Infection Score (CPIS) based on chest X-ray has been developed to facilitate clinical diagnosis of ventilator-associated pneumonia (VAP); however, this scoring system has a low diagnostic performance. We developed the Lung Ultrasound and Pentraxin-3 Pulmonary Infection Score (LUPPIS) for early diagnosis of VAP and evaluated the performance of this new scoring system.
Material and methods
In a prospective study of 78 patients with suspected VAP, we assessed the detection accuracy of LUPPIS for pneumonia in adult patients. We also evaluated the diagnostic performance of pentraxin-3 (PTX-3) findings of infection. On the day of the study, lung ultrasound was performed, PTX-3 levels were determined, and an endotracheal aspirate was obtained for Gram staining and culture.
Results
No significant differences were found between groups with respect to age, mechanical ventilation time, APACHE II score, or SOFA score (p > 0.05). Procalcitonin and PTX-3 levels were significantly higher in the VAP (+) group (p < 0.001 and p < 0.001, respectively). The threshold for LUPPIS in differentiating VAP (+) patients from VAP (â) patients was > 7. In predicting VAP, LUPPIS > 7 (sensitivity of 84%, specificity of 87.7%) was superior to CPIS > 6 (sensitivity of 40.1%, specificity of 84.5%).
Conclusions
LUPPIS appears to provide better results in the prediction of VAP compared to CPIS, and the importance of lung ultrasound and PTX-3 is emphasized, which is a distinctive property of LUPPIS.
中文翻译：
呼吸机相关性肺炎早期诊断新评分系统：LUPPIS。
引言
基于胸部 X 线的临床肺部感染评分 (CPIS) 已被开发用于促进呼吸机相关性肺炎 (VAP) 的临床诊断；但是，该评分系统的诊断性能较低。我们开发了用于早期诊断 VAP 的肺超声和 Pentraxin-3 肺部感染评分 (LUPPIS)，并评估了这种新评分系统的性能。
材料与方法
在一项对 78 名疑似 VAP 患者的前瞻性研究中，我们评估了 LUPPIS 对成人患者肺炎的检测准确性。我们还评估了 pentraxin-3 (PTX-3) 感染发现的诊断性能。在研究当天，进行了肺部超声检查，测定了 PTX-3 水平，并获得了气管内吸出物用于革兰氏染色和培养。
结果
在年龄、机械通气时间、APACHE II 评分或 SOFA 评分方面，各组之间未发现显着差异（p > 0.05）。VAP (+) 组的降钙素原和 PTX-3 水平显着升高（分别为 p < 0.001 和 p < 0.001）。区分 VAP (+) 患者和 VAP (-) 患者的 LUPPIS 阈值 > 7。在预测 VAP 时，LUPPIS > 7（敏感性为 84%，特异性为 87.7%）优于 CPIS > 6（敏感性为40.1%，特异性 84.5%）。
结论
与 CPIS 相比，LUPPIS 在预测 VAP 方面似乎提供了更好的结果，并且强调了肺部超声和 PTX-3 的重要性，这是 LUPPIS 的一个独特特性。
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