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. 2020 Aug 3;10(1):101.
doi: 10.1186/s13613-020-00721-4.

Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia

Alexandre Gaudet  1   2 , Ignacio Martin-Loeches  3   4 , Pedro Povoa  5   6 , Alejandro Rodriguez  7   8 , Jorge Salluh  9 , Alain Duhamel  10   11 , Saad Nseir  12   13 ; TAVeM study group
Affiliations

Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia

Alexandre Gaudet et al. Ann Intensive Care. .

Abstract

Background: Differentiating Ventilator-Associated Tracheobronchitis (VAT) from Ventilator-Associated Pneumonia (VAP) may be challenging for clinicians, yet their management currently differs. In this study, we evaluated the accuracy of the Clinical Pulmonary Infection Score (CPIS) to differentiate VAT and VAP.

Methods: We performed a retrospective analysis based on the data from 2 independent prospective cohorts. Patients of the TAVeM database with a diagnosis of VAT (n = 320) or VAP (n = 369) were included in the derivation cohort. Patients admitted to the Intensive Care Centre of Lille University Hospital between January 1, 2016 and December 31, 2017 who had a diagnosis of VAT (n = 70) or VAP (n = 139) were included in the validation cohort. The accuracy of the CPIS to differentiate VAT from VAP was assessed within the 2 cohorts by calculating sensitivity and specificity values, establishing the ROC curves and choosing the best threshold according to the Youden index.

Results: The areas under ROC curves of CPIS to differentiate VAT from VAP were calculated at 0.76 (95% CI [0.72-0.79]) in the derivation cohort and 0.67 (95% CI [0.6-0.75]) in the validation cohort. A CPIS value ≥ 7 was associated with the highest Youden index in both cohorts. With this cut-off, sensitivity and specificity were respectively found at 0.51 and 0.88 in the derivation cohort, and at 0.45 and 0.89 in the validation cohort.

Conclusions: A CPIS value ≥ 7 reproducibly allowed to differentiate VAT from VAP with high specificity and PPV and moderate sensitivity and NPV in our derivation and validation cohorts.

Keywords: CPIS; Lower respiratory tract infection; Mechanical ventilation; Pneumonia; Tracheobronchitis.

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Conflict of interest statement

SN reports personal fees from MSD, Pfizer, Gilead, Bio Rad, and Biomerieux, outside the submitted work; other authors have no competing interest to disclose. The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Values of CPIS in patients with VAT and VAP in the derivation (a) and validation (b) cohorts. Box plot shows the median (horizontal line) and IQR (25th 75th percentile) (box). The whiskers show the lowest data within 1.5 IQR of the lower quartile and highest data within 1.5 IQR of the upper quartile. Data outside 1.5 IQR of the upper or lower quartiles are depicted with a dot. CPIS Clinical Pulmonary Infection Score; VAP Ventilator-Associated Pneumonia; VAT Ventilator-Associated Tracheobronchitis
Fig. 2
Fig. 2
ROC curves of CPIS for the diagnosis of VAP amongst patients with VA LRTI in the derivation (a) and validation (b) cohorts. A sensitivity analysis was performed for the accuracy of CPIS in diagnosing VAP amongst patients with VA LRTI and ROC curves were computerized in derivation and validation cohorts. CPIS Clinical pulmonary infection score, VAP Ventilator-associated pneumonia, VAT Ventilator-associated tracheobronchitis, VA LRTI Ventilator-associated lower respiratory tract infection
Fig. 3
Fig. 3
Scatter dot plots of CPIS in patients with VAT and VAP in the derivation (a) and validation (b) cohorts relatively to the 7-point cut-off. The CPIS value is depicted as a single dot for each patient. Dash lines separate patients with a CPIS value ≥ 7 from those with a CPIS value < 7. CPIS Clinical pulmonary infection score, VAP Ventilator-associated pneumonia, VAT Ventilator-associated tracheobronchitis
See this image and copyright information in PMC

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