Plasma endocan and cleaved endocan for the diagnosis of microbiologically confirmed ventilator-associated pneumonia in intensive care patients

Résumé fourni par la source

Endocan and its major catabolite cleaved endocan are reported as potential biomarkers of pneumonia in the setting of critical illness. However, very little is known about their accuracy to discriminate microbiologically confirmed ventilator-associated pneumonia (VAP) at the time of clinical suspicion. The objective of this study was to evaluate the performance of endocan and cleaved endocan for the early discrimination of microbiologically confirmed VAP. In a pre-planned ancillary analysis of the single-center prospective observational SOH-VAP cohort (NCT03434821) which was conducted at the University hospital of Lille from March 2018 to April 2022, patients presenting with a clinical suspicion of VAP leading to microbiological respiratory sampling were included. Endocan and cleaved endocan were measured on EDTA plasma collected on the day of VAP clinical suspicion. The performance of these biomarkers and of the endocan cleavage ratio (ECR) was determined by comparing values obtained in patients with microbiologically confirmed VAP to those without microbiological confirmation, and by establishing ROC curves. We enrolled 47 patients with microbiologically confirmed VAP and 67 patients without microbiological confirmation. No significant differences were found when comparing endocan, cleaved endocan, and ECR values between confirmed and non-confirmed VAP (median [IQR] = 5 [2.7; 9.6] ng/mL vs. 4.7 [2.5; 8.5] ng/mL, p = 0.86 for endocan; 1.2 [0; 2] ng/mL vs. 1 [0; 2] ng/mL, p = 0.71 for cleaved endocan; and 0.06 [0; 0.32] vs. 0.07 [0; 0.29], p = 0.94 for ECR). Areas under the ROC curves for differentiating confirmed and non-confirmed VAP were respectively calculated at 0.51 (95% CI: 0.4-0.62) for endocan, 0.52 (95% CI: 0.43-0.64) for cleaved endocan, and 0.52 (95% CI: 0.41-0.63) for ECR. Our results do not support the use of endocan nor cleaved endocan for the early detection of microbiologically confirmed VAP at the time of clinical suspicion.

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