Contribution of clinical pulmonary infection score in the diagnosis of hospital acquired pneumonia

Introduction and aim: Clinical pulmonary infection score (CPIS) is a scoring system calculated by symptoms and signs of pneumonia, that is used in the diagnosis and management of hospital acquired pneumonia (HAP). In this study, the contribution of CPIS for diagnosis of HAP was investigated in intensive care unit (ICU) patients. Methods: The ICU patients followed-up between February 2008 and September 2010 were assessed retrospectively. Hospital acquired pneumonia was diagnosed by quantitative endotracheal aspirate (ETA). CPIS was calculated on 3rd and 7th days of ICU admission. The correlations of CPIS with concurrent ETA cultures and laboratory markers of infection were assessed. Results: Out of 240 patients (165 men, mean age 58.2±16.6 yrs) included in the study, ETA cultures were positive in 61 patients (25.4%) on 3rd day, and in 59 patients (24.6%) on 7th day. CPIS was found higher in patients with ETA culture positive (5.0±2.3 vs. 3.5±2.1 on 3rd day, p<0.0001; 5.2±2.6 vs. 3.6±2.9 on 7th day, p<0.0001). Sensitivity and specificity ratios of CPIS with a threshold level of 6.5 in diagnosis of HAP were 26.2% and 92.3% for 3rd day; 30.5% and 91.9% for 7th day, respectively. On 3rd and 7th days, there were positive correlations between CPIS and C-reactive protein (CRP) levels (p=0.002 and p=0.001, respectively); and also between CPIS and procalcitonin (PCT) levels (p=0.012 and p<0.0001, respectively). Conclusion: Clinical pulmonary infection score can be used instead of infection markers like CRP and PCT in the diagnosis of hospital acquired pneumonia.