Alveolar and serum procalcitonin: diagnostic and prognostic value in ventilator-associated pneumonia

Anesthesiology. 2002 Jan;96(1):74-9. doi: 10.1097/00000542-200201000-00018.


Background: The potential role of serum and alveolar procalcitonin as early markers of ventilator-associated pneumonia (VAP) and its prognostic value were investigated.

Methods: Ninety-six patients with a strong suspicion of VAP were prospectively enrolled. VAP diagnosis was based on a positive quantitative culture obtained via a mini-bronchoalveolar lavage of 103 colony-forming units/ml or more. Blood and alveolar samples were collected for procalcitonin measurement and analyzed for diagnostic and prognostic evaluation on days 0, 3, and 6. Sensitivity, specificity, positive likelihood ratio, and receiver-operating characteristic curves were analyzed to define ideal cutoff values and approach the decision analysis.

Results: Serum procalcitonin was significantly increased in the VAP group (n = 44) compared with the non-VAP group (n = 52): 11.5 ng/ml (95% confidence interval, 5.9-17.0) versus 1.5 ng/ml (1.1-1.9). A serum procalcitonin concentration greater than 3.9 ng/ml (best cutoff value) was considered positive for the VAP diagnosis (sensitivity, 41%; specificity, 100%). Serum procalcitonin was significantly increased in the non-survivors compared with the survivors for the VAP group: 16.5 ng/ml (95% confidence interval, 8.1-24.9) versus 2.9 ng/ml (1.2-4.7). The best cutoff value for serum procalcitonin of the nonsurvivors in the VAP group was 2.6 ng/ml (sensitivity, 74%; specificity, 75%; positive likelihood ratio, 2.96). Regarding VAP diagnosis and prognosis, no significant differences were found for alveolar procalcitonin in all groups.

Conclusions: Serum but not alveolar procalcitonin seems to be a helpful parameter in the early VAP diagnosis and an appropriate marker for predicting mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchoalveolar Lavage Fluid / chemistry
  • Calcitonin / analysis*
  • Calcitonin / blood
  • Calcitonin Gene-Related Peptide
  • Female
  • Humans
  • Interleukin-6 / physiology
  • Male
  • Middle Aged
  • Pneumonia / diagnosis*
  • Pneumonia / metabolism
  • Pneumonia / mortality
  • Prognosis
  • Protein Precursors / analysis*
  • Protein Precursors / blood
  • Pulmonary Alveoli / chemistry*
  • Tumor Necrosis Factor-alpha / physiology
  • Ventilators, Mechanical / adverse effects*


  • CALCA protein, human
  • Interleukin-6
  • Protein Precursors
  • Tumor Necrosis Factor-alpha
  • Calcitonin
  • Calcitonin Gene-Related Peptide