Prognosis of ventilator-associated pneumonia: what lies beneath.

V entilator-associated pneumonia (VAP) continues to be a major problem in the care of intensive care unit (ICU) patients. The incidence of VAP in mechanically ventilated patients is high, ranging from 10 to 30%. The clinical symptoms of VAP are ambiguous and there is no generally accepted gold standard for the diagnosis of VAP. The associated mortality is still high at 30–40% [1, 2]. Established clinical scores and biomarkers are only of limited value in terms of diagnosis and prognosis. Since VAP is an infectious disease we traditionally use biomarkers of infection for diagnostic and prognostic purposes. Inflammatory markers such as leukocyte count and C-reactive protein (CRP) are still widely used in the diagnosis of VAP, although it is well known that sensitivity in the ICU setting is highly limited.