The role of clinical infection scores and soma infection biomarkers in diagnosis and follow-up in hospital acquired pneumonia

Hospital-acquired pneumonia (HAP) is the second most common infection among all nosocomial infections, which has the highest mortality rates. It has been shown that starting treatment as soon as the diagnosis was administered is effective on the mortality rates. But clinicians need some scoring systems and biomarkers to evaluate the treatment responses during the early period and to decide whether to continue the treatment or not.The aim of the study was to determine the effect of ``clinical pulmonary infection score?? (CPIS) and the infection biomarkers; C-reactive protein (CRP) and procalcitonin (PCT) on the treatment and to the mortality rates during the follow up period, as well as the association between CPIS, CRP and PCT.25 patients with HAP were included in this study. After performing CPIS, CRP and PCT assays, suitable antibiotic treatment was initiated at first day according to TTD Hospital-acquired pneumonia Diagnosis and Treatment Task Force recommendations. On the 3rd day CPIS evaluation and on the 4th day CRP and PCT analysis were repeated. All the patients? one month mortality rates were recorded.Among the 25 patients, there were 14 female (%56) and 11 males (%44). The mean age of the patients was 65,60 ± 15,16 years. The mean duration for HAP development was 9,4±8,2 days. No association between age and CPIS, CRP, PCT, HAP development duration, hospital stay time and mortality rate was found. However, the correlation analysis yielded that as the age increased HAP development duration decreased. Among the CPIS parameters, we demonstrated a significant change between the first and the follow-up values of fever (p=0,046), leukocyte (p=0,001), PaO2/FiO2(p=0,016), secretion presence (p=0,001), culture positivity (p=0,01) as well as total CPIS (p=0,030). However, there wasn?t a significant difference in CRP and PCT levels. We couldn?t show any relation between CPIS domains, total CPIS, CRP, PCT, HAP development duration and admission duration as well as mortality rates.As a result, CPIS was found to be better in monitoring the HAP treatment than the biomarkers such as CRP and PCT. However, none of them had an effect on mortality. Studies including more patients are necessary to make precise comments.