calca-protein--human and Nervous-System-Diseases

The role and impact of systemic inflammatory response after aneurysmal subarachnoid hemorrhage remain to be elucidated.. To assess the time course and correlation of systemic inflammatory parameters with outcome and the occurrence of delayed ischemic neurological deficits (DINDs) after subarachnoid hemorrhage.. Besides the baseline characteristics, daily interleukin-6 (IL-6), procalcitonin, C-reactive protein levels, and leukocyte counts were prospectively measured until day 14 after subarachnoid hemorrhage. Occurrence of infectious complications and application of therapeutic hypothermia were assessed as confounding factors. The primary end point was outcome after 3 months, assessed by Glasgow outcome scale; the secondary end point was the occurrence of DINDs.. During a 3-year period, a total of 138 patients were included. All inflammatory parameters measured were higher in patients with unfavorable outcome (Glasgow outcome scale score, 1-3). After adjustment for confounding factors, elevated IL-6 and leukocyte counts remained significant risk factors for unfavorable outcome. The odds ratio for log IL-6 was 4.07 (95% confidence interval, 1.18 to 14.03; P = .03) and for leukocyte counts was 1.24 (95% confidence interval, 1.06-1.46, P = .008). The analysis of the time course established that IL-6 was the only significantly elevated parameter in the early phase in patients with unfavorable outcome. Higher IL-6 levels in the early phase (days 3-7) were associated with the occurrence of DINDs. The adjusted odds ratio for log IL-6 was 4.03 (95% confidence interval, 1.21-13.40; P = .02).. Higher IL-6 levels are associated with worse clinical outcome and the occurrence of DINDs. Because IL-6 levels were significantly elevated in the early phase, they might be a useful parameter to monitor.

Topics: Adult; Aged; Biomarkers; Brain Ischemia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cerebral Angiography; Confidence Intervals; Endpoint Determination; Female; Glasgow Outcome Scale; Humans; Hypothermia, Induced; Inflammation; Interleukin-6; Leukocyte Count; Logistic Models; Male; Middle Aged; Nervous System Diseases; Odds Ratio; Prospective Studies; Protein Precursors; ROC Curve; Sample Size; Subarachnoid Hemorrhage; Treatment Outcome

Outcome of carotid endarterectomy (CEA) is defined by mortality rate as well as the neurological outcome due to cerebral ischemia. Thus the aim of this study was to evaluate the role of the acute phase protein procalcitonin (PCT) as a predictor for neurological deficits after carotid endarterectomy.. Fifty-five patients with high grade stenosis of the internal carotid artery and interdisciplinary consensus for endarterectomy were followed. Neurological examination was performed before and after the procedure to analyze perioperative neurological deficits. Blood samples were obtained before and after CEA and procalcitonin was analyzed in 55 consecutive patients (65.5% symptomatic/34.5% asymptomatic).. No perioperative or in-hospital death was observed. Major complications did not occur, two patients suffered from bleeding requiring surgical intervention and one patient had a temporary peripheral facial nerve lesion. Postoperative neurological examination revealed no new deficit, there was no significant change of PCT (level pre- and post-CEA (the mean preoperative PCT was 0.25 ng/mL [SD 0.78, min 0.1, max 4.3]; the mean postoperative PCT was 0.11 ng/mL [SD 0.06, min 0.1, max 0.5]). There was no association found between perioperative neurological deficit and PCT.. The present study demonstrates that there is still not sufficient evidence to recommend PCT measurement as a predictor for perioperative neurological deficit during CEA.

Topics: Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Nervous System Diseases; Neurologic Examination; Odds Ratio; Predictive Value of Tests; Protein Precursors; Risk Assessment; Severity of Illness Index; Treatment Outcome

Some mediators of inflammation are associated with sepsis, involving nervous system. Proinflammatory cytokines, TNF-alpha, IL-6, and IL-8, and procalcitonin (PCT), proinflammatory protein, were investigated in patients with neurologic complications in sepsis. TNF-alpha, IL-6, IL-8, and PCT were prospectively investigated in 62 patients with neurologic complications in sepsis. TNF-alpha and IL-6 were studied both in serum as in the CSF, IL-8 and PCT were studied only in serum. TNF-alpha, IL-6, and IL-8 were studied by ELISA (R & D Systems), and the PCT by immunoluminometric assay (BRAHMS). Mean value of TNF-alpha in serum was 578+/-214 pg/ml, and in CSF was 458+/-167 pg/ml (p<0.01). Mean value of IL-6 in serum was 749+/-213 pg/ml, and in CSF was 617.5+/-182 pg/ml (p<0.01). Mean value of IL-8 in serum was 332+/-196 pg/ml (p<0.01). Mean value of PCT in serum was 80+/-16 ng/ml (p<0.01). The investigated parameters do not permit the identifying of cases with neurologic complications. The increased correlation coefficient between cytokines in serum and in CSF suggests the damage of the blood-brain barrier. The raise of PCT in serum, induced by TNF-alpha and IL-6, is an argument of the severity of sepsis.

Topics: Aged; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Interleukin-6; Interleukin-8; Male; Nervous System Diseases; Protein Precursors; Sepsis; Tumor Necrosis Factor-alpha