Biomarkers and lung ultrasound to predict pneumonia in patients of lung laceration or contusion after traumatic chest injury
CCCF ePoster library. Samanta S. 11/13/19; 283379; EP113
Dr. Sukhen Samanta
Dr. Sukhen Samanta
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Topic: Retrospective or Prospective Cohort Study or Case Series

Sukhen Samanta, Sujay Samanta, Ajay Chaudhary, Manas Kumar Banerjee, Satyajit Bose
Department of Critical Care, The Mission Hospital ,Durgapur,West Bengal, India

Introduction: Pneumonia may present as a life-threatening infection with uncertain progression and response to treatment after lung laceration in traumatic chest injury patients. Early detection and initiation of antimicrobial agents are of utmost importance to save life.
Objectives: The objective of this study is to know whether biomarkers( procalcitonin and C reactive protein) and lung ultrasound can predict pneumonia in traumatic lung laceration patients as the literature is deficient in this regard.
Methods: This is a prospective observational study of 34 patients having traumatic lung laceration or contusion on computed tomography scan. Patients who had a clinical pulmonary infection score (CPIS )≥ 5 (excluding microbiology variable) were included in this study. Patients with microbiologically confirmed pneumonia and consolidation on CT at admission were excluded from the study. Serum procalcitonin (PCT), N terminal brain natriuretic peptide (NT-Pro BNP), C-reactive protein(CRP) and culture of blood,sputum/endotracheal aspirate were sent within 8 hours of study inclusion. Twelve points lung ultrasound was also performed by intensivist at bedside within 8 hours of inclusion. Presence of consolidation in lung parenchyma and or air bronchogram were considered pneumonia. Sputum or endotracheal aspirate( ETA) culture ≥ 104 was considered as confirmed diagnosis of pneumonia.
Results: Incidence of pneumonia was 32%(11/34) with the majority being male (91%). Patients with pneumonia and without pneumonia had PCT, CRP and NT-Pro BNP values of 5ng/ml;85.4 mg/L ;689pg/ml and 0.3 ng/ml;80 mg/L;420 pg/ml respectively (p= 0.001, p=0.33, p=0.25). CPIS(including microbiology variable) and SOFA score were more in the pneumonia group (7 versus 6; 7 versus 6 respectively). Sixty one percent (21/34) of patients were mechanically ventilated. Number of days of mechanical ventilation, ICU stay and hospital stay were more in the pneumonia group compared to the non-pneumonia group (4 versus 3,7 versus 4 and 14 versus 7 days respectively). Two patients died in the pneumonia group and culture report showed extreme drug resistant Klebsiella pneumoniae. Sensitivity and specificity of PCT and CRP to predict pneumonia was 90% ;83% and 72% ;56% respectively at cut off values of 1ng/dl and 100mg/L. Sensitivity and specificity of Lung ultrasound to predict pneumonia were 82% and 87% respectively. Area under receiver operating characteristic curve for PCT, CRP and Lung ultrasound were 0.91,0.60 and 0.84 respectively.  
Conclusions: Serum procalcitonin was preferred biomarker over CRP to predict pneumonia in traumatic lung injury patients. Lung ultrasound yielded good sensitivity and specificity. Authors warrant prospective large trial combining biomarker with lung ultrasound to predict pneumonia in lung laceration or contusion patients.

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  1. Sakran JVMichetti CPSheridan MJ, et al The utility of procalcitonin in critically ill trauma patients .J Trauma Acute Care Surg. 2012;73:413-8
  2. Zagli G, Cozzolino M, Terreni A, et al . Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new core based on procalcitonin and chest echography.Chest. 2014;146(6):1578-1585
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