Evaluation of the Kinetics of Pancreatic Stone Protein as a Predictor of Ventilator-Associated Pneumonia

Adrian Ceccato; Marta Camprubí-Rimblas; Lieuwe D J Bos; Pedro Povoa; Ignacio Martin-Loeches; Carles Forné; Aina Areny-Balagueró; Elena Campaña-Duel; Luis Morales-Quinteros; Sara Quero; Paula Ramirez; Mariano Esperatti; Antoni Torres; Lluis Blanch; Antonio Artigas

doi:10.3390/biomedicines11102676

Evaluation of the Kinetics of Pancreatic Stone Protein as a Predictor of Ventilator-Associated Pneumonia

Biomedicines. 2023 Sep 29;11(10):2676. doi: 10.3390/biomedicines11102676.

Authors

Adrian Ceccato^{1

2

3}, Marta Camprubí-Rimblas^{1

2}, Lieuwe D J Bos⁴, Pedro Povoa^{5

6

7}, Ignacio Martin-Loeches^{2

8

9}, Carles Forné^{10

11}, Aina Areny-Balagueró^{1

2}, Elena Campaña-Duel^{1

2}, Luis Morales-Quinteros^{1

2

12}, Sara Quero^{1

2}, Paula Ramirez¹³, Mariano Esperatti^{14

15}, Antoni Torres^{2

9}, Lluis Blanch^{1

2}, Antonio Artigas^{1

2}

Affiliations

¹ Critical Care Center, Institut d'Investigació i Innovació Parc Taulí I3PT-CERCA, Hospital Universitari Parc Taulí, Univeristat Autonoma de Barcelona, 08208 Sabadell, Spain.
² CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain.
³ Intensive Care Unit, Hospital Universitari Sagrat Cor, Grupo Quironsalud, 08029 Barcelona, Spain.
⁴ Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
⁵ Department of Critical Care Medicine, Hospital de São Francisco Xavier, CHLO, 1449-005 Lisbon, Portugal.
⁶ Nova Medical School, New University of Lisbon, 1169-056 Lisbon, Portugal.
⁷ Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, 5000 Odense, Denmark.
⁸ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James Hospital, D08 NHY1 Dublin, Ireland.
⁹ Department of Pneumology, Hospital Clinic of Barcelona-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain.
¹⁰ Heorfy Consulting, 25007 Lleida, Spain.
¹¹ Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain.
¹² Servei de Medicina Intensiva, Hospital de la Santa Creu y Sant Pau, 08025 Barcelona, Spain.
¹³ Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain.
¹⁴ Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata B7602AYL, Argentina.
¹⁵ Unidad de Cuidados Intensivos, Hospital Privado de Comunidad, Mar del Plata B7602AYL, Argentina.

Abstract

Background: Ventilator-associated pneumonia (VAP) is a severe condition. Early and adequate antibiotic treatment is the most important strategy for improving prognosis. Pancreatic Stone Protein (PSP) has been described as a biomarker that increases values 3-4 days before the clinical diagnosis of nosocomial sepsis in different clinical settings. We hypothesized that serial measures of PSP and its kinetics allow for an early diagnosis of VAP.

Methods: The BioVAP study was a prospective observational study designed to evaluate the role of biomarker dynamics in the diagnosis of VAP. To determine the association between repeatedly measured PSP and the risk of VAP, we used joint models for longitudinal and time-to-event data.

Results: Of 209 patients, 43 (20.6%) patients developed VAP, with a median time of 4 days. Multivariate joint models with PSP, CRP, and PCT did not show an association between biomarkers and VAP for the daily absolute value, with a hazard ratio (HR) for PSP of 1.01 (95% credible interval: 0.97 to 1.05), for CRP of 1.00 (0.83 to 1.22), and for PCT of 0.95 (0.82 to 1.08). The daily change of biomarkers provided similar results, with an HR for PSP of 1.15 (0.94 to 1.41), for CRP of 0.76 (0.35 to 1.58), and for PCT of 0.77 (0.40 to 1.45).

Conclusion: Neither absolute PSP values nor PSP kinetics alone nor in combination with other biomarkers were useful in improving the prediction diagnosis accuracy in patients with VAP.

Clinical trial registration: Registered retrospectively on August 3rd, 2012. NCT02078999.

Keywords: biomarkers; pancreatic stone protein; prediction; ventilator-associated pneumonia.

Associated data

ClinicalTrials.gov/NCT02078999

Grants and funding

This study was partially supported by Abionic, CIBERES, and Research and Innovation Institute Parc Tauli (I3PT). A.C. acknowledges receiving financial support from Instituto de Salud Carlos III (ISCIII; Sara Borrell 2021: CD21/00087). The funding sources had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.