Serum Procalcitonin and C-reactive Protein as Markers of Sepsis and Outcome in Patients with Neurotrauma and Subarachnoid Haemorrhage

Abstract

This prospective study evaluated serum procalcitonin (PCT) and C-reactive protein (CRP) as markers for systemic inflammatory response syndrome (SIRS)/sepsis and mortality in patients with traumatic brain injury and subarachnoid haemorrhage. Sixty-two patients were followed for 7 days. Serum PCT and CRP were measured on days 0, 1, 4, 5, 6 and 7. Seventy-seven per cent of patients with traumatic brain injury and 83% with subarachnoid haemorrhage developed SIRS or sepsis (P=0.75). Baseline PCT and CRP were elevated in 35% and 55% of patients respectively (P=0.03). There was a statistically non-significant step-wise increase in serum PCT levels from no SIRS (0.4±0.6 ng/ml) to SIRS (3.05±9.3 ng/ml) to sepsis (5.5±12.5 ng/ml). A similar trend was noted in baseline PCT in patients with mild (0.06±0.9 ng/ml), moderate (0.8±0.7 ng/ml) and severe head injury (1.2±1.9 ng/ml). Such a gradation was not observed with serum CRP. There was a non-significant trend towards baseline PCT being a better marker of hospital mortality compared with baseline CRP (ROC-AUC 0.56 vs 0.31 respectively). This is the first prospective study to document the high incidence of SIRS in neurosurgical patients. In our study, serum PCT appeared to correlate with severity of traumatic brain injury and mortality. However, it could not reliably distinguish between SIRS and sepsis in this cohort. This is in part because baseline PCT elevation seemed to correlate with severity of injury. Only a small proportion of patients developed sepsis, thus necessitating a larger sample size to demonstrate the diagnostic usefulness of serum PCT as a marker of sepsis. Further clinical trials with larger sample sizes are required to confirm any potential role of PCT as a sepsis and outcome indicator in patients with head injuries or subarachnoid haemorrhage.

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

“…Our results are in agreement with a study by O'Connor E et al in 2004 [20] that evaluated PCT and CRP as mortality markers in 62 patients with TBI and subarachnoid haemorrhage and they found that serum PCT appeared to correlate with TBI severity and mortality.…”

Appendiceal fecalith is associated with early perforation in pediatric patients

“…Serum CRP values reflect the acute phase protein response to injury stimuli and have been shown to correlate well with injury severity [17]. Metabolic stress response analysis using CRP has been shown to be valuable in stratifying the magnitude and duration of injury and in predicting outcome after injury in a variety of patient populations [18][19][20][21]. A recent prospective study of children with acute appendicitis showed improved sensitivity and specificity of serum CRP levels in contrast to WCC when diagnosing appendiceal perforation [22].…”

The systemic implications of aneurysmal subarachnoid hemorrhage

“…Several studies have evaluated the prevalence of SIRS following SAH [6][7][8]12,206,207]. In a series of 207 SAH patients, SIRS or sepsis were identified as the primary cause of death in 67 patients (32.6%).…”