Impact of body temperature and serum procalcitonin on the outcomes of critically ill neurological patients

Abstract

Introduction: Fever is common in patients with acute stroke, and mostly it is due to infectious complications. The neurologic effects of fever are significant, increased temperature in the post-injury period has been associated with increased cytokine activity and increased infarct size.Aim: To test the hypothesis that fever and increased serum procalcitonin are associated with poor outcomes after neurological injury.Methodology: Fifty patients (30 males (60%) and 20 females (40%) mean 43.8 ± 11.7 years) were divided into two groups: Group I: 25 traumatic patients (i.e., head injury) and Group II: 25 non-traumatic patients (i.e., stroke). Temperature was measured from admission until the patients were discharged or died, and PCT was measured on day 1 of admission and after 48 h of admission.Results: Fever has been associated with poor outcome, as fever is linked to worse GCS scores (12.6 ± 1.2 vs. 7.7 ± 2.6 in patients with fever, P 0.001), longer MV durations (3.6 ± 1.0 vs. 22.4 ± 9.1 days, in patients with fever, P 0.001), longer ICU length of stay (8.1 ± 4.7 vs. 23.0 ± 8.0 days in patients with fever, P 0.001) and increased mortality (P = 0.001). There were significantly higher PCT levels in the mortality group versus the survived group at day 1 (4.15 ± 0.82 vs. 2.47 ± 0.059 ng/ml, respectively, P 0.0001) and after 48 h of admission (5.20 ± 1.14 vs. 3.19 ± 0.092 ng/ml, respectively, P 0.0001).Conclusion: Fever had a strong link to worse GCS, longer MV durations, increased length of ICU stay, higher mortality rates and worse overall outcomes in neurocritical patients. High PCT levels can predict mortality in those patients. Ó 2015 Production and hosting by Elsevier B.V. on behalf of The Egyptian College of Critical CarePhysicians.

The effectiveness of clinical pathway‐directed care on hospitalisation‐related outcomes in patients with severe traumatic brain injury: A quasi‐experimental study

“…Patients with severe traumatic brain injury are particularly prone to developing infections and sepsis because clinical symptoms and conventional markers are not always reliable indicators of infection in this patient group. Adding to this, patients with Glasgow Coma Scale scores less than nine (as is the case in severe TBI) have relatively higher rates of upper airway microbial colonisation (Feasal, El Azab, Mashhour, & El Hadidy, ), possible attributed to the aspiration of high inoculum oropharyngeal secretions immediately following brain injury, during resuscitation and as a result of intubation. The presence of long‐term invasive devices such as urinary catheters or intravenous cannulae compounds this risk (McClelland & Moxon, ).…”