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Early systemic procalcitonin levels in patients with aneurysmal subarachnoid hemorrhage


Muroi, C; Lemb, J B; Hugelshofer, M; Seule, M A; Bellut, D; Keller, E (2014). Early systemic procalcitonin levels in patients with aneurysmal subarachnoid hemorrhage. Neurocritical Care, 21(1):73-77.

Abstract

Background - Early (B24 h) systemic procalcitonin (PCT) levels are predictive for unfavorable neurological outcome in patients after out-of-hospital cardiac arrest (OHCA). Subarachnoid hemorrhage (SAH) due to aneurysm rupture might lead to a cerebral perfusion stop similar to OHCA. The current study analyzed the association of early PCT levels and outcome in patients after SAH.
Methods - Data from 109 consecutive patients, admitted within 24 h after SAH, were analyzed. PCT levels were measured within 24 h after ictus. Clinical severity was determined using the World Federation of Neurological Societies (WFNS) scale and dichotomized into severe (grade 4–5) and non-severe (1–3). Neurological outcome after 3 months was assessed by the Glasgow outcome scale and dichotomized into unfavorable (1–3) and favourable (4–5). The predictive value was assessed using receiver operating curve (ROC) analysis.
Results - Systemic PCT levels were significantly higher in patients with severe SAH compared to those with nonsevere SAH: 0.06 ± 0.04 versus 0.11 ± 0.11 lg/l (median ± interquartile range; p < 0.01). Patients with unfavorable outcome had significantly higher PCT levels compared to those with favorable outcome 0.09 ± 0.13 versus 0.07 ± 0.15 ng/ml (p < 0.01). ROC analysis showed an area under the curve of 0.66 (p < 0.01) for PCT, which was significantly lower than that of WFNS with 0.83 (p < 0.01).
Conclusions - Early PCT levels in patients with SAH might reflect the severity of the overall initial stress response. However, the predictive value is poor, especially compared to the reported predictive values in patients with OHCA. Early PCT levels might be of little use in pre- dicting neurological outcome after SAH.

Abstract

Background - Early (B24 h) systemic procalcitonin (PCT) levels are predictive for unfavorable neurological outcome in patients after out-of-hospital cardiac arrest (OHCA). Subarachnoid hemorrhage (SAH) due to aneurysm rupture might lead to a cerebral perfusion stop similar to OHCA. The current study analyzed the association of early PCT levels and outcome in patients after SAH.
Methods - Data from 109 consecutive patients, admitted within 24 h after SAH, were analyzed. PCT levels were measured within 24 h after ictus. Clinical severity was determined using the World Federation of Neurological Societies (WFNS) scale and dichotomized into severe (grade 4–5) and non-severe (1–3). Neurological outcome after 3 months was assessed by the Glasgow outcome scale and dichotomized into unfavorable (1–3) and favourable (4–5). The predictive value was assessed using receiver operating curve (ROC) analysis.
Results - Systemic PCT levels were significantly higher in patients with severe SAH compared to those with nonsevere SAH: 0.06 ± 0.04 versus 0.11 ± 0.11 lg/l (median ± interquartile range; p < 0.01). Patients with unfavorable outcome had significantly higher PCT levels compared to those with favorable outcome 0.09 ± 0.13 versus 0.07 ± 0.15 ng/ml (p < 0.01). ROC analysis showed an area under the curve of 0.66 (p < 0.01) for PCT, which was significantly lower than that of WFNS with 0.83 (p < 0.01).
Conclusions - Early PCT levels in patients with SAH might reflect the severity of the overall initial stress response. However, the predictive value is poor, especially compared to the reported predictive values in patients with OHCA. Early PCT levels might be of little use in pre- dicting neurological outcome after SAH.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:21 Feb 2014 11:11
Last Modified:08 Dec 2017 03:48
Publisher:Springer
ISSN:1541-6933
Publisher DOI:https://doi.org/10.1007/s12028-013-9844-z
PubMed ID:23839707

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