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Early Systemic Procalcitonin Levels in Patients with Aneurysmal Subarachnoid Hemorrhage

Muroi, Carl ; Lemb, Johanna ; Hugelshofer, Michael ; Seule, Martin ; Bellut, David ; Keller, Emanuela

In: Neurocritical Care, 2014, vol. 21, no. 1, p. 73-77

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    Titre
    • Early Systemic Procalcitonin Levels in Patients with Aneurysmal Subarachnoid Hemorrhage
    Auteur
    • Muroi, Carl. Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
    • Lemb, Johanna. Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
    • Hugelshofer, Michael. Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
    • Seule, Martin. Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
    • Bellut, David. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
    • Keller, Emanuela. Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Neurocritical Care, 2014, vol. 21, no. 1, p. 73-77. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:324924
    Summary
    Background: Early (≤24h) 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 24h after SAH, were analyzed. PCT levels were measured within 24h 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 3months was assessed by the Glasgow outcome scale and dichotomized into unfavorable (1-3) and favorable (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 non-severe SAH: 0.06±0.04 versus 0.11±0.11μg/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±0.15ng/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 predicting neurological outcome after SAH.