Does C-Reactive Protein, Mean Platelet Volume and Red Cell Distribution Width Predict Ventilator-Associated Events in Mechanically Ventilated Patients?

Background: To investigate the role of C-reactive protein, procalcitonin, mean platelet volume (MPV), red cell distribution width (RDW), neutrophil–lymphocyte ratio (NLR) and other parameters of complete blood count on predictive value in patients with ventilator association events (VAE). Material and Methods: Seventy-six patients admitted to the intensive care unit of our institute -a tertiary center- with required mechanical ventilation between March 2019 and July 2019 were retrospectively recruited in the study. Demographic and clinical data including age, gender and laboratory test results were retrospectively collected from medical records and electronic databases. The study population was divided into two groups according to the development of VAE as VAE group or non-VAE group. Results: Twenty-nine subjects developed of VAE during the in hospital course (VAE group) and 47 subjects didn’t develop of VAE (non-VAE group). MPV, RDW, NLR, CRP and procalcitonin were significantly higher in the VAE group compared to that of the non-VAE group. Multiple logistic regression revealed that CRP, MPV and RDW were independent predictors of development of VAE in patients with mechanical ventilated. ROC curve analysis indicated a cut-off value 8.46 mg/dL for CRP (sensitivity 76%, specificity 74%), a cut-off value of 9.35 fl for MPV (sensitivity 69%, specificity 70%) and a cut-off value of 14.80 % for RDW (sensitivity 59%, specificity 58%) to predict development of VAE in patients with mechanical ventilated. Conclusion: CRP, acute phase reactant, MPV, as an emerging indicator of preexisting inflammation, and RDW, indicative of systemic inflammation might have predictive diagnostic value invivo of VAE.

Keywords:

Ventilator-association events mean platelet volume,

PDF

___

1. Dudeck MA, Weiner LM, Allen-Bridson K, et. al. National Healthcare Safety Network (NHSN) Report, Data Summary for 2012, Device-associated Module. Am J Infect Control 2013;41:1148-66.
2. National Healthcare Safety Network: surveillance for ventilator-associated events, January 2019. Center for Disease Control and Prevention website. http://www.cdc.gov 3. Cocoros NM, Klompas M. Ventilator-Associated Events and Their Prevention. Infect Dis Clin North Am 2016; 30:887-908.
4. Park Y, Schoene N, Haris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets 2002;13:301-306.
5. Kamath S, Blann AD, Lip GY. Platelet activation: assessment and quantification. Eur Heart J 2001;22:1561-1571.
6. Iannacone M. Platelet-mediated modulation of adaptive immunity. Semin Immunol 2016;28:555-560.
7.Becchi C, Al Malyan M, Fabbri LP, Marsili M, Boddi V, Boncinelli S. Mean platelet volume trend in sepsis: is it a useful parameter? Minerva Anestesiol 2006;72: 749–756.
8.Canpolat FE, Yurdakök M, Armangil D, Yigit S. Mean platelet volume in neonatal respiratory distress syndrome. Pediatr Int 2009;51: 314–316.
9. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J ThrombHaemost 2010;8: 148–156.
10. Kostrubiec M, Łabyk A, Pedowska-Włoszek J, Hrynkiewicz-Szyman´ska A, Pacho S, Jankowski K, Lichodziejewska B, Pruszczyk P. Mean platelet volume predicts early death in acute pulmonary embolism. Heart 2010;96: 460–465.
11. OnderI,TopcuS,DokmetasHS,TurkayC,Seyﬁkli Z. Platelet aggregation size and volume in chronic obstructive pulmonary disease. Mater Med Pol 1997;29: 11–13.
12. Zhang Z, Xu X, Ni H, Deng H. Platelet indices are novel predictors of hospital mortality in intensive care unit patients. J Crit Care 2014; 29: 885.e1-6.
13.Sezgi C, Taylan M, Kaya H, Selimoglu Sen H, Abakay O, Demir M, Abakay A, Tanrikulu AC. Alterations in platelet count and mean platelet volume as predictors of patient outcome in the respiratory intensive care unit. ClinRespir J 2015;9:403-408.
14. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009;169:588–594.
15.Felker GM, Allen LA, Pocock SJ, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 2007; 50:40–47.
16. Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, Kang KW, Kim J, Rhee JE. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013;31:545-548.
17.Zorlu A, Bektasoglu G, Guven FMK, Dogan OT, Kucuk E, Ege MR , Altay H , Çınar Z , Tandoğan I , Yılmaz MB . Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012;109:128-134.
18.Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Red Cell Distribution Width and all cause mortality in critically ill patients. Crit Care Med 2011;39:1913-1921.
19. Imtiaz F, Shafique K, Mirza SS,Ayoob Z , Vart P , Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012;5:2.
20. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5-14. 21. de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremiabetter than conventional infection markers in an emergency care unit. Crit Care 2010;14(5):R192. 22. Papa A, Emdin M, Passino C, et al. Predictive value of elevated neutrophil–lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395:27-31.
23.Cedrés S, Torrejon D, Martinez A, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol 2012;14:864-869. 24. Walsh SR, Cook E, Goulder F, et al. Neutrophil lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005;91:181-184.
25. Hatherill M, Tibby SM, Sykes K, Turner C, Murdoch IA. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child 1999;81:417-21.
26. Dominguez-Comesana E, Estevez-Fernandez SM, Lopez-Gomez V, Ballinas-Miranda J, Dominguez-Fernandez R. Procalcitonin and C-reactive protein as early markers of postoperative intra-abdominal infection in patients operated on colorectal cancer. Int J Colorect Dis 2017.
27. Tachyla SA, Marochkov AV, Lipnitski AL, Nikiforova YG. The prognostic value of procalcitonin, C-reactive protein and cholesterol in patients with an infection and multiple organ dysfunction. Korean J Anesthesiol 2017;70:305-10.
28. Hillas G, Vass ilakopoulos T, Plantza P, Rasidakis A, Bakakos P. C-reactive protein and procalcitonin as predictors of survival and septic shock in ventilator-associated pneumonia. Eur Respir J 2010; 35:805-811.
29. Kiaei BA, Ghiasi F, Moradi D. Precalcitonin and C-reactive protein as markers in response to antibiotic treatment in ventilator-associated pneumonia in intensive care unit-hospitalized patients. Adv Biomed Res 2015; 4: 240.
30. Chen C, Yan M, Hu C, Lv X, Zhang H, Chen S. Diagnostic efficacy of serum procalcitonin, C-reactive protein concentration and clinical pulmonary infection score in Ventilator-Associated Pneumonia. Med Sci 2018;34 :26-32.
31. Povoa P, Martin-Loeches I, Ramirez P, Bos LD, Esperatti M, Silvestre J, Gili G, Goma G, Berlanga E, Espasa M, Goncalves E, Torres A, Artigas A. Biomarker kinetics in the prediction of VAP diagnosis: results from the BioVAP study. Ann Intensive Care 2016; 6: 32.
32. Habib SF, Mukhtar AM, Abdelreheem HM, Khorshied MM, El Sayed R, Hafez MH, Gouda HM, Ghaith DM, Hasanin AM, Eladawy AS, Ali MA, Fouad AZ. Diagnostic values of CD64, C-reactive protein and procalcitonin in ventilator-associated pneumonia in adult trauma patients: a pilot study. Clin Chem Lab Med 2016; 54: 889-895.
33. Jiao J, Wang M, Zhang J, Shen K, Liao X, Zhou X. Procalcitonin as a diagnostic marker of ventilator-associated pneumonia in cardiac surgery patients. Exp Ther Med 2015; 9: 1051-1057.
34. Tanriverdi H, Tor MM, Kart L, Altin R, Atalay F, Sumbuloglu V. Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia. Ann Thorac Med 2015; 10: 137-142.
35. Kolls JK. Oxidative stress in sepsis: a redox redux. J Clin Invest 2006;116:860–863.

Journal of Immunology and Clinical Microbiology-Cover

Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 2016
Yayıncı: Erkan YULA

Arşiv

Sayıdaki Diğer Makaleler

Common clinical manifestations and the Thorax CT features of Coronavirus Disease 2019 (Covid-19) by stages

Serdar SERİNSÖZ, Cahit DEMİR

Analgesics effect of intra-articular bupivacaine injection on pain score in anterior cruciate ligament surgery: a randomized clinical trial

Serdar MENEKŞE