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Accuracy of alpha amylase in diagnosing microaspiration in intubated critically-ill patients Dewavrin F; Zerimech F; Boyer A; Maboudou P; Balduyck M; Duhamel A; Nseir SPLoS One 2014[]; 9 (6): e90851OBJECTIVES: Amylase concentration in respiratory secretions was reported to be a potentially useful marker for aspiration and pneumonia. The aim of this study was to determine accuracy of alpha-amylase in diagnosing microaspiration in critically ill patients. METHODS: Retrospective analysis of prospectively collected data collected in a medical ICU. All patients requiring mechanical ventilation for at least 48 h, and included in a previous randomized controlled trial were eligible for this study, provided that at least one tracheal aspirate was available for alpha-amylase measurement. As part of the initial trial, pepsin was quantitatively measured in all tracheal aspirates during a 48-h period. All tracheal aspirates were frozen, allowing subsequent measurement of alpha-amylase for the purpose of the current study. Microaspiration was defined as the presence of at least one positive tracheal aspirate for pepsin (>200 ng.mL-1). Abundant microaspiration was defined as the presence of pepsin at significant level in >74% of tracheal aspirates. RESULTS: Amylase was measured in 1055 tracheal aspirates, collected from 109 patients. Using mean alpha-amylase level per patient, accuracy of alpha-amylase in diagnosing microaspiration was moderate (area under the receiver operator curve 0.72+/-0.05 [95%CI 0.61-0.83], for an alpha-amylase value of 1685 UI.L-1). However, when alpha-amylase levels, coming from all samples, were taken into account, area under the receiver operator curve was 0.56+/-0.05 [0.53-0.60]. Mean alpha-amylase level, and percentage of tracheal aspirates positive for alpha-amylase were significantly higher in patients with microaspiration, and in patients with abundant microaspiration compared with those with no microaspiration; and similar in patients with microaspiration compared with those with abundant microaspiration. alpha-amylase and pepsin were significantly correlated (r2 = 0.305, p = 0.001). CONCLUSION: Accuracy of mean alpha-amylase in diagnosing microaspiration is moderate. Further, when all alpha-amylase levels were taken into account, alpha-amylase was inaccurate in diagnosing microaspiration, compared with pepsin.|Aged[MESH]|Biomarkers/metabolism[MESH]|Female[MESH]|Humans[MESH]|Intubation, Intratracheal[MESH]|Male[MESH]|Middle Aged[MESH]|Pepsin A/metabolism[MESH]|ROC Curve[MESH]|Respiration, Artificial[MESH]|Respiratory Aspiration/*diagnosis/enzymology[MESH]|Respiratory Insufficiency/therapy[MESH]|Retrospective Studies[MESH]|Trachea/enzymology[MESH]|alpha-Amylases/*metabolism[MESH] |
