eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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5/2020
vol. 16
 
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Pulmonology
abstract:
Clinical research

A new scoring system for early diagnosis of ventilator-associated pneumonia: LUPPIS

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

1.
Department of Anesthesiology and Intensive Care, School of Medicine, Marmara University, Istanbul, Turkey
2.
Department of Infectious Disease, School of Medicine, Marmara University, Istanbul, Turkey
Arch Med Sci 2020; 16 (5): 1040–1048
Online publish date: 2020/08/10
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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 (–) 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.

keywords:

ventilator-associated pneumonia, Clinical Pulmonary Infection Score, lung ultrasound, pentraxin-3

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