calca-protein--human and Heart-Arrest

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Coma; Female; Heart Arrest; Humans; Hypothermia, Induced; Hypoxia; Male; Protein Precursors; Reperfusion Injury

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Heart Arrest; Humans; Protein Precursors; Survival Rate

To investigate serial serum concentrations of procalcitonin (PCT) and C-reactive protein (CRP) in patients treated with mild hypothermia after cardiac arrest, and to study their association to severe infections, post cardiac arrest syndrome (PCAS) and long-term outcome.. Serum samples from cardiac arrest patients treated with mild hypothermia were collected serially at admission, 2, 6, 12, 24, 36, 48 and 72 h after cardiac arrest. PCT and CRP concentrations were determined and tested for association with three definitions of infection, two surrogate markers of PCAS (circulation-SOFA and time to return of spontaneous circulation (ROSC)) and cerebral performance category (CPC) at six months.. Eighty-four patients were included. PCT displayed an earlier release pattern than CRP with a significant increase within 2h, increasing further at 6h and onwards in patients with poor outcome. CRP increased later and continued to rise during the study period. PCT was strongly associated with circulation-SOFA and time to ROSC, and predicted a poor neurologic outcome with high accuracy (area under the receiver operating characteristic curve of 0.88, 0.86 and 0.87 at 12, 24 and 48 h respectively). No association of PCT or CRP to infection was observed.. Our results suggest that PCT is released early after resuscitation following cardiac arrest, is associated with markers of PCAS but not with infection, and is an accurate predictor of poor outcome. Validation of these findings in larger studies is warranted.

Topics: Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Heart Arrest; Humans; Hypothermia, Induced; Male; Middle Aged; Prospective Studies; Protein Precursors; Reperfusion Injury; Severity of Illness Index; Sweden; Treatment Outcome

To examine the relationship of early serum procalcitonin (PCT) levels with the severity of post-cardiac arrest syndrome (PCAS), long-term neurological recovery and the risk of early-onset infections in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH).. A prospective cohort of adult comatose CA patients treated with TH (33°C, for 24h) admitted to the medical/surgical intensive care unit, Lausanne University Hospital, was studied. Serum PCT was measured early after CA, at two time-points (days 1 and 2). The SOFA score was used to quantify the severity of PCAS. Diagnosis of early-onset infections (within the first 7 days of ICU stay) was made after review of clinical, radiological and microbiological data. Neurological recovery at 3 months was assessed with Cerebral Performance Categories (CPC), and was dichotomized as favorable (CPC 1-2) vs. unfavorable (CPC 3-5).. From December 2009 to April 2012, 100 patients (median age 64 [interquartile range 55-73] years, median time from collapse to ROSC 20 [11-30]min) were studied. Peak PCT correlated with SOFA score at day 1 (Spearman's R=0.44, p<0.0001) and was associated with neurological recovery at 3 months (peak PCT 1.08 [0.35-4.45]ng/ml in patients with CPC 1-2 vs. 3.07 [0.89-9.99] ng/ml in those with CPC 3-5, p=0.01). Peak PCT did not differ significantly between patients with early-onset vs. no infections (2.14 [0.49-6.74] vs. 1.53 [0.46-5.38]ng/ml, p=0.49).. Early elevations of serum PCT levels correlate with the severity of PCAS and are associated with worse neurological recovery after CA and TH. In contrast, elevated serum PCT did not correlate with early-onset infections in this setting.

Topics: Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Coma; Female; Heart Arrest; Humans; Hypothermia, Induced; Hypoxia; Infections; Intensive Care Units; Male; Middle Aged; Prospective Studies; Protein Precursors; Risk Factors; Severity of Illness Index; Switzerland; Treatment Outcome

Early onset pneumonia is frequently reported after cardiac arrest, despite the fact that therapeutic hypothermia and post-resuscitation disease manifestations make it difficult to diagnose. We aimed to assess the ability of serum procalcitonin (PCT) measurements to help diagnose pneumonia in this setting.. Retrospective study of consecutive patients admitted to a single academic medical intensive care unit (ICU) for successfully resuscitated cardiac arrest (July 2006-March 2008). All patient files were reviewed to assess the development of pneumonia during the first 5 days of ICU stay. Serum PCT was measured at admission, days (D) 1, 2 and 3.. Among 132 patients included, pneumonia was diagnosed in 86, and antibiotics were initiated in 115 patients during the first 5 days. PCT was significantly higher in patients with pneumonia at D1 (4.58 vs. 1.03 ng/ml, p = 0.017), D2 (3.76 vs. 0.73, p = 0.002) and D3 (3.76 vs. 0.73, p = 0.046). Areas under the ROC curves were 0.59 at admission, 0.64 at D1, 0.68 at D2 and 0.63 at D3. Using a threshold of 0.5 ng/ml, negative predictive values were 39% at admission, 42% at D1 and 52% at D2, whereas positive predictive values were 72, 68 and 70%, respectively. Patients with post-resuscitation shock (n = 66) had significantly higher PCT levels than vasopressor-free patients from D1 to D3.. The diagnostic value of PCT is poor after cardiac arrest and should not be performed to assess early onset pneumonia. The post-resuscitation disease itself could play a major role in this lack of specificity and predictive value.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Resuscitation; Diagnosis, Differential; Female; Heart Arrest; Humans; Hypothermia, Induced; Intensive Care Units; Length of Stay; Male; Middle Aged; Pneumonia; Protein Precursors; Retrospective Studies

In past research, procalcitonin (PCT) and glial fibrillary acidic protein (GFAP) have been reported to be useful biomarkers in predicting neurological outcome after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (CA), although they have only been studied separately. In this study, we compared the usefulness of PCT and GFAP in predicting neurological outcome.. This study was a retrospective, single-center analysis, conducted in the intensive-care unit of a university hospital. Twenty-one sequential post-CA patients were included. Serum samples were collected from patients at 12 and 24 h after ROSC. Serum PCT and GFAP were measured and compared in patients with favorable and unfavorable neurological outcomes, evaluated at 6 months using the Glasgow-Pittsburgh Cerebral Performance Categories.. Serum PCT was significantly higher at 12 and 24 h in patients with unfavorable outcomes (P = 0.004 and 0.002, respectively). Serum GFAP was not significantly higher at 12 and 24 h in patients with unfavorable outcomes (P = 0.118 and 0.079, respectively). The combination of PCT and GFAP showed high predictive value for unfavorable outcomes (86.7% sensitivity and 100% specificity at 12 h; 100% sensitivity and 83.3% specificity at 24 h).. Serum PCT is a marker of unfavorable neurological outcome in post-CA patients, and is superior to serum GFAP in the early phase.

Topics: Adult; Aged; Brain; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Resuscitation; Cerebrovascular Circulation; Female; Glial Fibrillary Acidic Protein; Heart Arrest; Humans; Male; Middle Aged; Predictive Value of Tests; Protein Precursors; Retrospective Studies; Survival Rate; Treatment Outcome

The aim of this study was to investigate time course of procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) levels in patients with therapeutic hypothermia after cardiac arrest.. We retrospectively assessed laboratory and clinical data in a consecutive cohort of patients admitted to the medical intensive-care-unit of the University Hospital in Basel, Switzerland, in whom therapeutic hypothermia was induced because of cardiac arrest between December 2007 and January 2009. Infection was considered based on microbiological evidence (restricted definition) and/or clinical evidence of infection with prescription of antibiotics (extended definition).. From 34 included patients, 25 had respiratory tract infection based on the clinical judgment and in 18 microbiological cultures turned positive (restricted definition). PCT concentrations were highest on the first day after hypothermia and showed a steady decrease until day 7 without differences in patients with and without presumed infection. CRP concentrations increased to a peak level at days 3-4 followed by a steady decrease; CRP concentrations were higher in patients with clinical diagnosis of infection on day 4 (P = 0.02); and in patients with evidence of bacterial growth in cultures on days 4 and 5 (P = 0.01 and P = 0.006). WBC remained unchanged after hypothermia without differences between patients with and without infection.. High initial values of PCT and high peak levels after 3-4 days of CRP were found in patients with induction of hypothermia after cardiac arrest. This increase was unspecific and mirrors rather an inflammatory reaction than true underlying infection, limiting the diagnostic potential for early antibiotic stewardship in these patients.

Topics: Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Heart Arrest; Humans; Hypothermia; Leukocytes; Male; Middle Aged; Protein Precursors; Respiratory Tract Infections; Retrospective Studies; Switzerland; Time Factors

Topics: Aged; Brain Damage, Chronic; Calcitonin; Calcitonin Gene-Related Peptide; Female; Heart Arrest; Humans; Male; Middle Aged; Predictive Value of Tests; Protein Precursors

Topics: Brain Damage, Chronic; Calcitonin; Calcitonin Gene-Related Peptide; Heart Arrest; Humans; Predictive Value of Tests; Protein Precursors

Although animal studies document conflicting data on the influence of hypothermia on cytokine release in various settings, no data exist if hypothermia affects the inflammatory response after successful cardiopulmonary resuscitation.. Arrest- and treatment-related variables of 71 patients were documented, and serum samples were analyzed for levels of interleukin 6, tumor necrosis factor-alpha, C-reactive protein, and procalcitonin immediately after hospital admission and after 6, 24, and 120 hours. At day 14, patients were dichotomized in those with good and bad neurological outcome.. Regardless of outcomes, interleukin 6 levels were significantly elevated by the use of hypothermia (n = 39). The rate of bacterial colonization was significantly higher in hypothermic patients (64.1 vs 12.5 %; P < .001). On the contrary, procalcitonin levels were, independent of the use of hypothermia, only significantly elevated in patients with bad neurological outcome. Hypothermic patients showed a strong trend to reduced mortality. However, there was no influence on neurological recovery.. In this observational study, hypothermia influenced the inflammatory response after cardiopulmonary resuscitation and lead to a higher rate of bacterial colonization without altering ultimate neurologic recovery.

Topics: Aged; Aged, 80 and over; Bacteremia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Resuscitation; Cytokines; Female; Heart Arrest; Humans; Hypothermia, Induced; Inflammation; Interleukin-6; Male; Middle Aged; Protein Precursors; Treatment Outcome; Tumor Necrosis Factor-alpha

Procalcitonin (PCT) and C reactive protein (CRP) have been used as infection parameters. PCT increase correlates with the infection's severity, course, and mortality. Post-cardiocirculatory arrest syndrome may be related to an early systemic inflammatory response, and may possibly be associated with an endotoxin tolerance. Our objective was to report the time profile of PCT and CRP levels after paediatric cardiac arrest and to assess if they could be use as markers of immediate survival.. A retrospective observational study set in an eight-bed PICU of a university hospital was performed during a period of two years. Eleven children younger than 14 years were admitted in the PICU after a cardiac arrest. PCT and CRP plasma concentrations were measured within the first 12 and 24 hours of admission.. In survivors, PCT values increased 12 hours after cardiac arrest without further increase between 12 and 24 hours. In non survivors, PCT values increased 12 hours after cardiac arrest with further increase between 12 and 24 hours. Median PCT values (range) at 24 hours after cardiac arrest were 22.7 ng/mL (0.2 - 41.0) in survivors vs. 205.5 ng/mL (116.6 - 600.0) in non survivors (p < 0.05). CRP levels were elevated in all patients, survivors and non-survivors, at 12 and 24 hours without differences between both groups.. Measurement of PCT during the first 24 hours after paediatric cardiac arrest could serve as marker of mortality.

Topics: Adolescent; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Resuscitation; Child; Child, Preschool; Female; Heart Arrest; Humans; Infant; Intensive Care Units, Pediatric; Male; Protein Precursors; Retrospective Studies; Time Factors

Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) and procalcitonin (PCT) are often considered to be specific markers for infection. We evaluated plasma levels of sTREM-1 and PCT in patients with systemic inflammatory response syndrome but no sepsis. Noninfected patients undergoing elective heart surgery with cardiopulmonary bypass (n = 76) and patients admitted after out-of-hospital cardiac arrest (n = 54) were followed up for 3 days. Patients with severe sepsis (n = 55) and healthy volunteers (n = 31) were included as positive and negative controls, respectively. Plasma levels of PCT were higher in sepsis patients than in patients who survived after cardiac arrest or after heart surgery. In contrast, peak plasma levels of sTREM-1 in heart surgery and in cardiac arrest patients overlapped with those measured in patients with sepsis. Both sTREM-1 and PCT were significantly higher in cardiac arrest patients who died of refractory shock than in those who died of neurological failure or survived without major neurological damage. In the cardiac arrest patients with refractory shock, sTREM-1 and PCT levels were similar to those in the patients with severe sepsis. In conclusion, sTREM-1 and PCT are not specific for infection and can increase markedly in acute inflammation without infection.

Topics: Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Female; Heart Arrest; Humans; Male; Membrane Glycoproteins; Middle Aged; Protein Precursors; Receptors, Immunologic; Sepsis; Thoracic Surgery; Triggering Receptor Expressed on Myeloid Cells-1

The time course of Procalcitonin (PCT) serum levels was assessed in cardiac arrest survivors and compared with S-100 serum levels concerning their predictive values for neurological outcome. PCT and S-100 serum levels were analyzed serially on admission and during the following 3 days after hospitalization in 23 patients successfully resuscitated from out-of-hospital cardiac arrest. At day 14 patients were divided into groups according to the Glasgow-Outcome-Scale (GOS): one group with bad neurological outcome (GOS 1-3) and one group with good neurological outcome (GOS 4-5). Group comparisons were performed with the Mann-Whitney U-Test. The diagnostic performance of PCT and S-100 levels was analyzed using receiver operating characteristics (ROC). Patients with a bad neurological outcome had significantly higher S-100 levels than those with a good neurological outcome at all investigated time points and significantly elevated PCT levels at days 1-3. Highest levels for S-100 were found immediately after hospitalization (3.4 +/- 3.8 vs. 0.7 +/- 0.3 microg/l, P=0.003), and for PCT at day 1 (37 +/- 103 vs. 0.2 +/- 0.2 microg/l, P=0.0002). The results show that PCT serum levels are possibly elevated in patients with bad neurological outcome after cardiac arrest, without signs of severe infection or concomitant sepsis. Based on this observation, studies on larger numbers of patients should prove the predictive value of PCT in those patients.

Topics: After-Hours Care; Aged; Calcitonin; Calcitonin Gene-Related Peptide; Female; Heart Arrest; Humans; Hypoxia, Brain; Male; Protein Precursors; S100 Proteins

A possible diagnostic role of procalcitonin (PCT) as a marker for ventilator associated pneumonia (VAP) in patients with an already triggered acute phase response after successful cardiopulmonary resuscitation (CPR) was investigated. In 28 patients with return of spontaneous circulation (ROSC) after out of hospital CPR, measurements of PCT, C-reactive protein (CrP), white blood cell count (WBC) and body temperature were compared with the clinical course of the patients. In this setting, PCT was the only marker to differentiate between patients with and without VAP (median value on day 1, 6.0 vs. 0.5 ng/ml; P<0.001). Using a cut off value of 1 ng/ml during the first 7 days after ROSC PCT had a sensitivity of 100% and a specificity of 75% to indicate VAP. PCT was elevated a median of 2 days earlier than the clinical diagnosis of VAP. Elevations in PCT can, therefore, indicate bacterial complications in cardiac arrest patients with a non-infectious acute phase response.

Topics: Adult; Aged; Body Temperature; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Middle Aged; Pneumonia; Prospective Studies; Protein Precursors; Respiration, Artificial; Sensitivity and Specificity; Time Factors