The Indian Journal of Pediatrics

, Volume 85, Issue 6, pp 426–432 | Cite as

New Biomarkers to Diagnose Ventilator Associated Pneumonia: Pentraxin 3 and Surfactant Protein D

  • Nazan Ulgen TekerekEmail author
  • Basak Nur Akyildiz
  • Baris Derya Ercal
  • Sabahattin Muhtaroglu
Original Article



To detect the most effective biomarker to confirm ventilator associated pneumonia (VAP).


Fifty patients with VAP suspicious diagnosis and 30 healthy patients were recruited. Suspicion of VAP was established if patients met the modified CPIS score ≥ 6 points. The confirmation of VAP was defined by the quantitative culture of nonbronchoscopic bronchoalveolar lavage (BAL) >105 CFU/ml of pathogenic microorganism. Serum samples for determination of C-reactive protein (CRP), procalcitonin (PCT), pentraxin 3 (PTX3), surfactant protein D (SPD) were collected on suspected VAP.


Twenty seven of 50 patients were accepted as confirmed VAP group whose nonbronchoscopic BAL cultures were positive and rest of them were accepted as unconfirmed VAP group. PTX3, PCT and SPD levels were significantly higher in confirmed VAP group, (P = 0.021, P = 0.007, P < 0.001 respectively). There were no significant differences in CRP levels between the two groups (P = 0.062). The most sensitive marker for diagnosing VAP was SPD (P < 0.001). Receiver operating characteristic (ROC) curve for modified clinical pulmonary infection score (CPIS) to confirm VAP was evaluated (AUC 0.741 ± 0.07, P < 0.001) and the optimal cutoff value was >7 with a sensitivity of 51.85% and a specificity of 91.3%. SPD levels were significantly higher in Acinetobacter baumannii and Pseudomonas aeruginosa infected patients than culture negative patients (P < 0.001).


The index findings suggest that serum SPD is the most sensitive biomarker in diagnosis of VAP and it can be used as an early and organism specific marker for Acinetobacter baumannii and Pseudomonas aeruginosa.


Surfactant protein D Pentraxin 3 Ventilator associated pneumonia 



Area under ROC curve


Bronchoalveolar lavage


Colony forming units


Clinical pulmonary infection score


C-reactive protein


Enzyme-linked immunosorbent assay




Pediatric logistic organ dysfunction


Pediatric intensive care unit


Pediatric risk of mortality


Pentraxin 3


Receiver operating characteristic


Surfactant protein D


Ventilator associated pneumonia



NUT and BNA conceptualized the study and its design. NUT and BNA participated in data collection and diagnostic work-up of study participants. BDE and SM analyzed and interpreted the data. NUT drafted the manuscript, which was revised after critical inputs from BNA, SM, BDE. All authors approved the final version of the manuscript, as submitted. BNA is consultant of incharge and will act as guarantor for this paper.

Source of Funding

This work was supported by the BAP commity of Erciyes University.

Compliance with Ethical Standards

Conflict of Interest



  1. 1.
    Beardsley AL, Nitu ME, Cox EG, Benneyworth BD. An evaluation of various ventilator-associated infection criteria in a PICU. Pediatr Crit Care Med. 2016;17:73–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev. 2007;20:409–25.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gupta S, Boville BM, Blanton R, et al. A multicentered prospective analysis of diagnosis, risk factors, and outcomes associated with pediatric ventilator-associated pneumonia. Pediatr Crit Care Med. 2015;16:e65–73.CrossRefPubMedGoogle Scholar
  4. 4.
    Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A. Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance. Infect Control Hosp Epidemiol. 2004;25:753–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Elward AM, Warren DK, Fraser VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics. 2002;109:758–64.CrossRefPubMedGoogle Scholar
  6. 6.
    Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics. 2009;123:1108–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Fischer JE, Ramser M, Fanconi S. Use of antibiotics in pediatric intensive care and potential savings. Intensive Care Med. 2000;26:959–66.CrossRefPubMedGoogle Scholar
  8. 8.
    Rea-Neto A, Youssef NC, Tuche F, et al. Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Crit Care. 2008;12:R56.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Hillas G, Vassilakopoulos T, Plantza P, Rasidakis A, Bakakos P. C-reactive protein and procalcitonin as predictors of survival and septic shock in ventilator-associated pneumonia. Eur Respir J. 2010;35:805–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Horonenko G, Hoyt JC, Robbins RA, et al. Soluble triggering receptor expressed on myeloid cell-1 is increased in patients with ventilator-associated pneumonia: a preliminary report. Chest. 2007;132:58–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Lin Q, Fu F, Shen L, Zhu B. Pentraxin 3 in the assessment of ventilator-associated pneumonia: an early marker of severity. Heart Lung. 2013;42:139–45.CrossRefPubMedGoogle Scholar
  13. 13.
    Said AS, Abd-Elaziz MM, Farid MM, Abd-ElFattah MA, Abdel-Monim MT, Doctor A. Evolution of surfactant protein-D levels in children with ventilator-associated pneumonia. Pediatr Pulmonol. 2012;47:292–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Bottazzi B, Garlanda C, Cotena A, et al. The long pentraxin PTX3 as a prototypic humoral pattern recognition receptor: interplay with cellular innate immunity. Immunol Rev. 2009;227:9–18.CrossRefPubMedGoogle Scholar
  15. 15.
    Bottazzi B, Vouret-Craviari V, Bastone A, et al. Multimer formation and ligand recognition by the long pentraxin PTX3. Similarities and differences with the short pentraxins C-reactive protein and serum amyloid P component. J Biol Chem. 1997;272:32817–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Mauri T, Coppadoro A, Bellani G, et al. Pentraxin 3 in acute respiratory distress syndrome: an early marker of severity. Crit Care Med. 2008;36:2302–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Hartl D, Griese M. Surfactant protein D in human lung diseases. Eur J Clin Investig. 2006;36:423–35.CrossRefGoogle Scholar
  18. 18.
    Wu H, Kuzmenko A, Wan S, et al. Surfactant proteins A and D inhibit the growth of gram-negative bacteria by increasing membrane permeability. J Clin Invest. 2003;111:1589–602.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Fartoukh M, Maitre B, Honore S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med. 2003;168:173–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Venkatachalam V, Hendley JO, Willson DF. The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med. 2011;12:286–96.CrossRefPubMedGoogle Scholar
  21. 21.
    Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C, Menon G. Clinical pulmonary infection score to diagnose ventilator-associated pneumonia in children. Indian Pediatr. 2011;48:949–54.CrossRefPubMedGoogle Scholar
  22. 22.
    Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C, Menon G. Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: a comparative study of bronchoscopic and nonbronchoscopic methods. Pediatr Crit Care Med. 2010;11:258–66.CrossRefPubMedGoogle Scholar
  23. 23.
    Kawasaki Y, Endo K, Suyama K, et al. Serum SP-D levels as a biomarker of lung injury in respiratory syncytial virus bronchiolitis. Pediatr Pulmonol. 2011;46:18–22.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  1. 1.Department of Pediatric Intensive CareErciyes University Faculty of MedicineKayseriTurkey
  2. 2.Department of MicrobiologyErciyes University Faculty of MedicineKayseriTurkey
  3. 3.Department of BiochemistryErciyes University Faculty of MedicineKayseriTurkey

Personalised recommendations