BackgroundTo propose a combination of blood biomarkers for the prediction of hospital-acquired pneumonia (HAP) and for the selection of traumatic brain-injured (TBI) patients eligible for corticosteroid therapy for the prevention of HAP.MethodsThis was a sub-study of the CORTI-TC trial, a multicenter, randomized, double-blind, controlled trial evaluating the risk of HAP at day 28 in 336 TBI patients treated or not with corticosteroid therapy. Patients were between 15 and 65 years with severe traumatic brain injury (Glasgow coma scale score ≤ 8 and trauma-associated lesion on brain CT scan) and were enrolled within 24 h of trauma. The blood levels of CRP and cortisoltotal&free, as a surrogate marker of the pro/anti-inflammatory response balance, were measured in samples collected before the treatment initiation. Endpoint was HAP on day 28.ResultsOf the 179 patients with available samples, 89 (49.7%) developed an HAP. Cortisoltotal&free and CRP blood levels upon ICU admission were not significantly different between patients with or without HAP. The cortisoltotal/CRP ratio upon admission was 2.30 [1.25–3.91] in patients without HAP and 3.36 [1.74–5.09] in patients with HAP (p = 0.021). In multivariate analysis, a cortisoltotal/CRP ratio > 3, selected upon the best Youden index on the ROC curve, was independently associated with HAP (OR 2.50, CI95% [1.34–4.64] p = 0.004). The HR for HAP with corticosteroid treatment was 0.59 (CI95% [0.34–1.00], p = 0.005) in patients with a cortisoltotal/CRP ratio > 3, and 0.89 (CI95% [0.49–1.64], p = 0.85) in patients with a ratio < 3.ConclusionA cortisoltotal/CRP ratio > 3 upon admission may predict the development of HAP in severe TBI. Among these patients, corticosteroids reduce the occurrence HAP. We suggest that this ratio may select the patients who may benefit from corticosteroid therapy for the prevention of HAP.

中文翻译：

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皮质醇总量/CRP比值用于预测创伤性脑损伤患者的医院获得性肺炎和开始皮质类固醇治疗

背景提出一种血液生物标志物的组合，用于预测医院获得性肺炎 (HAP) 和选择适合皮质类固醇治疗以预防 HAP 的创伤性脑损伤 (TBI) 患者。方法这是 CORTI 的子研究-TC 试验，一项多中心、随机、双盲、对照试验，评估了 336 名接受或未接受皮质类固醇治疗的 TBI 患者在第 28 天发生 HAP 的风险。患者年龄在 15 至 65 岁之间，患有严重的外伤性脑损伤（格拉斯哥昏迷量表评分 ≤ 8 分，脑 CT 扫描有外伤相关病变），并在外伤后 24 小时内入组。在治疗开始前收集的样本中测量 CRP 和皮质醇和游离皮质醇的血液水平，作为促/抗炎反应平衡的替代标志物。终点是第 28 天的 HAP。结果在有可用样本的 179 名患者中，89 名 (49.7%) 发生了 HAP。有或没有 HAP 的患者入住 ICU 时的皮质醇和游离皮质醇和 CRP 血液水平没有显着差异。入院时皮质醇/CRP 比率在无 HAP 患者中为 2.30 [1.25-3.91]，在 HAP 患者中为 3.36 [1.74-5.09]（p = 0.021）。在多变量分析中，根据 ROC 曲线上的最佳约登指数选择的皮质醇总/CRP 比值 > 3 与 HAP 独立相关（OR 2.50，CI95% [1.34–4.64] p = 0.004）。皮质醇总量/CRP 比值 > 3 的患者使用皮质类固醇治疗的 HAP 的 HR 为 0.59（CI95% [0.34–1.00]，p = 0.005），患者的 HR 为 0.89（CI95% [0.49–1.64]，p = 0.85）比值 < 3. 结论皮质醇总量/CRP 比值 > 3 入院时可预测严重 TBI 中 HAP 的发展。在这些患者中，皮质类固醇减少了HAP的发生。我们建议该比率可以选择可能受益于皮质类固醇治疗预防 HAP 的患者。