cliot (version 1.0.0)

cpis_vap_score: Clinical Pulmonary Infection Score (CPIS) for VAP

Description

Calculates the Clinical Pulmonary Infection Score (CPIS) to assist in the diagnosis of Ventilator-Associated Pneumonia (VAP). The score evaluates six clinical, physiological, radiographic, and microbiological variables. A score greater than 6 typically correlates with the presence of VAP (sensitivity 77%, specificity 42%).

Usage

cpis_vap_score(temp_c, wbc_count, band_forms_present, tracheal_secretions,
               pao2_fio2_ratio, ards_present, chest_xray, culture_results = 0)

Value

A list containing:

CPIS_Score

The calculated total score (Range 0-12).

Interpretation

Clinical suggestion ("Suggestive of VAP" if Score > 6).

Arguments

temp_c

Numeric. Body temperature in degrees Celsius. 36.5 - 38.4: 0 pts. 38.5 - 38.9: 1 pt. < 36.5 or >= 39.0: 2 pts.

wbc_count

Numeric. White Blood Cell count (cells/mm3 or uL). 4,000 - 11,000: 0 pts. < 4,000 or > 11,000: 1 pt (unless bands present).

band_forms_present

Numeric (0 or 1). Presence of >= 500 band forms. (1 = Yes). If WBC is abnormal AND bands are present, score is 2 pts.

tracheal_secretions

Numeric (0, 1, or 2). 0: Rare / Absence of tracheal secretions. 1: Abundant tracheal secretions. 2: Abundant + Purulent tracheal secretions.

pao2_fio2_ratio

Numeric. PaO2/FiO2 ratio (mmHg). > 240: 0 pts. <= 240: 2 pts (Only if ARDS is NOT present).

ards_present

Numeric (0 or 1). Presence of ARDS (Acute Respiratory Distress Syndrome). (1 = Yes). If ARDS is present, the oxygenation score is 0 regardless of the P/F ratio.

chest_xray

Numeric (0, 1, or 2). Chest radiograph findings. 0: No infiltrate. 1: Diffuse or patchy infiltrate. 2: Localized infiltrate.

culture_results

Numeric (0, 1, or 2). Culture of tracheal aspirate. Defaults to 0 if not yet available. 0: Negative or rare growth. 1: Pathogenic bacteria cultured (moderate/heavy). 2: Pathogenic bacteria cultured (moderate/heavy) + Same bacteria on Gram stain.

References

Pugin J, Auckenthaler R, Mili N, et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143(5 Pt 1):1121-1129. doi:10.1164/ajrccm/143.5_Pt_1.1121

Examples

# Example 1: Suggestive of VAP
# Temp 39.0 (+2), WBC 15k with Bands (+2), Purulent Secretions (+2),
# PF 200 No ARDS (+2), Localized CXR (+2), Culture Pending (0)
# Score = 10
cpis_vap_score(39.0, 15000, 1, 2, 200, 0, 2, 0)

# Example 2: Low Likelihood
# Temp 37.0 (0), WBC 8000 (0), Rare secretions (0), PF 300 (0), Diffuse CXR (1)
# Score = 1
cpis_vap_score(37.0, 8000, 0, 0, 300, 0, 1, 0)