Observational studyThorax2015
Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.
Observational study in Thorax, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 2 syntheses or guidelines pooled it, 86 citations in OpenAlex.
- Biomarkers in lower respiratory tract samples in the diagnosis of ventilator-associated pneumonia: a systematic review.European respiratory review : an official journal of the European Respiratory Society · 2025Pooled it
- Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care.BMC pulmonary medicine · 2021Pooled it
- Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation.The Lancet. Respiratory medicine · 2020Trial
- 16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia.Thorax · 2017Trial
- Trial
- Host-pathogen interactions during ESKAPE-mediated urinary tract infections and ventilator-associated pneumonia: a review.Folia microbiologica · 2026Review
- Alveolar dysregulation of host response in pneumonia and ARDS: implications for immune modulation and infection.Annals of intensive care · 2026Review
- Transforming Microbiological Diagnostics in Nosocomial Lower Respiratory Tract Infections: Innovations Shaping the Future.Diagnostics (Basel, Switzerland) · 2025Review
- An interpretable machine learning model for predicting in-hospital mortality in ICU patients with ventilator-associated pneumonia.PloS one · 2025Article
- Proteome signature for differential diagnosis of patients with bilateral lung infiltrates.ERJ open research · 2025Article
- D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care.Critical care (London, England) · 2024Article
- Analysis of Bacterial Metabolites in Breath Gas of Critically Ill Patients for Diagnosis of Ventilator-Associated Pneumonia-A Proof of Concept Study.Biomolecules · 2024Article
- A breath-based in vitro diagnostic assay for the detection of lower respiratory tract infections.PNAS nexus · 2024Article
- Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges.Nature communications · 2024Review
- How Does Airway Surface Liquid Composition Vary in Different Pulmonary Diseases, and How Can We Use This Knowledge to Model Microbial Infections?Microorganisms · 2024Review
- Observational
- Incidence, microbiological and immunological characteristics of ventilator-associated pneumonia assessed by bronchoalveolar lavage and endotracheal aspirate in a prospective cohort of COVID-19 patients: CoV-AP study.Critical care (London, England) · 2023Article
- Differentiating infection, colonisation, and sterile inflammation in critical illness: the emerging role of host-response profiling.Intensive care medicine · 2023Review
- Evaluation of Five Host Inflammatory Biomarkers in Early Diagnosis of Ventilator-Associated Pneumonia in Critically Ill Children: A Prospective Single Center Cohort Study.Antibiotics (Basel, Switzerland) · 2023Article
- Research Bronchoscopies in Critically Ill Research Participants: An Official American Thoracic Society Workshop Report.Annals of the American Thoracic Society · 2023Article
Corrections and comments
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Authors and funding
30 authors at 18 institutions in 3 countries.
Funding
Abstract
backgroundExcessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare.
objectivesWe sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP.
methodsA prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination.
resultsPaired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p<0.001). The area under the receiver operator characteristic curve for IL-1β was 0.81; IL-8, 0.74; MMP-8, 0.76; MMP-9, 0.79 and HNE, 0.78. A combination of IL-1β and IL-8, at the optimal cut-point, excluded VAP with a sensitivity of 100%, a specificity of 44.3% and a post-test probability of 0% (95% CI 0% to 9.2%).
conclusionsLow BALF IL-1β in combination with IL-8 confidently excludes VAP and could form a rapid biomarker-based rule-out test, with the potential to improve antibiotic stewardship.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.