calca-protein--human and Aneurysm--Ruptured

Procalcitonin (PCT) has been considered a more reliable marker than others because of its specificity for bacterial infection.. Case report and review of the literature.. A 50-year-old male was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage. We performed a ruptured aneurysm clipping and left unilateral external ventricular drainage. We also performed ventriculoperitoneal (VP) shunt placement in the course; however, VP shunt infection was indicated by fever, increased C-reactive protein concentration and leukocytosis. The cerebrospinal fluid culture showed methicillin-resistant Staphylococcus epidermidis but the serum PCT concentration was quite low.. Although PCT is considered a more reliable serological marker of bacterial meningitis in several reports, the serum PCT concentration did not reflect the bacterial VP shunt infection that was present in our case.

Topics: Aneurysm, Ruptured; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Humans; Intracranial Hemorrhages; Male; Methicillin Resistance; Middle Aged; Protein Precursors; Staphylococcal Infections; Staphylococcus epidermidis; Surgical Wound Infection; Ventriculoperitoneal Shunt

Early (≤24 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.. 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 favorable (4-5). The predictive value was assessed using receiver operating curve (ROC) analysis.. 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 ± 0.11 μg/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).. 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.

Topics: Adult; Aged; Aneurysm, Ruptured; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glasgow Outcome Scale; Humans; Inflammation; Intracranial Aneurysm; Male; Middle Aged; Prognosis; Protein Precursors; Severity of Illness Index; Subarachnoid Hemorrhage; Time Factors