PULMONOLOGY / CLINICAL RESEARCH
A new scoring system for early diagnosis of ventilator-associated pneumonia: LUPPIS
 
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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
Submission date: 2017-11-09
Final revision date: 2018-01-25
Acceptance date: 2018-02-05
Online publication date: 2020-08-10
Publication date: 2020-08-06
 
Arch Med Sci 2020;16(5):1040–1048
 
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ABSTRACT
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.

eISSN:1896-9151
ISSN:1734-1922