calca-protein--human and Stroke

Stroke-associated pneumonia is one of the most common causes of poor outcome in stroke patients. Clinical signs and laboratory parameters of stroke-associated infections are often inconclusive. Biomarkers may help to identify stroke patients at high risk for pneumonia and to guide physicians in an early antibiotic treatment, thereby improving stroke outcome.. The aim of the present study is to investigate whether procalcitonin ultrasensitive-guided antibiotic treatment improves functional outcome after severe ischaemic stroke by early treatment of pneumonia.. STRAWINSKI is an investigator-initiated, multicentre, randomized, controlled trial with blinded assessment of outcome comparing procalcitonin ultrasensitive-guided antibiotic treatment with standard care.. 200 patients with ischaemic stroke in the middle cerebral artery territory and a score >9 on the National Institutes of Health Stroke Scale will be included and randomly assigned to two groups. One group will receive procalcitonin-based antibiotic therapy guidance; the other group will receive standard stroke unit care.. The primary endpoint is functional outcome at day 90 after stroke on the modified Rankin Scale, dichotomized as favourable (0-4) or unfavourable outcome (5-6). Secondary endpoints are time to first event of death, rehospitalization, or recurrent stroke; death rate, infection rate, and days with fever up to day 7; length of hospital stay and hospital discharge disposition; shift analysis of the modified Rankin Scale; Barthel Index and days alive and out of hospital at day 90; use of antibiotics until day 90; and modified Rankin Scale, Barthel Index, and infarct volume at day 180.

Topics: Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cross Infection; Humans; Pneumonia; Protein Precursors; Research Design; Stroke

To determine whether serum procalcitonin (PCT) levels at admission were associated with short-term functional outcome after acute ischemic stroke (AIS) in a cohort Chinese sample. We prospectively studied 378 patients with AIS who were admitted within 24 h after the onset of symptoms. PCT and NIH stroke scale (NIHSS) were measured at the time of admission. Short-term functional outcome was measured by modified Rankin scale (mRS) 90 days after admission. The results indicated that the serum PCT levels were significantly higher in AIS patients as compared to normal controls (P < 0.0001). In the 114 patients with an unfavorable functional outcome, serum PCT levels were higher compared with those in patients with a favorable outcome (2.40 (IQR, 1.10-3.69) ng/mL and 0.42 (IQR, 0.10-1.05) ng/mL, respectively, P < 0.001). PCT was an independent prognostic marker of functional outcome [odds ratio (OR) 3.45 (2.29-4.77), adjusted for the NIHSS and other possible confounders] in patients with ischemic stroke, added significant additional predictive value to the clinical NIHSS score. In receiver operating characteristic curve analysis, the prognostic accuracy of PCT was higher compared to Hs-CRP and NIHSS score. PCT is an independent predictor of short-term functional outcome after ischemic stroke in Chinese sample even after correcting for possible confounding factors.

Topics: Aged; Asian People; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Protein Precursors; Recovery of Function; Stroke; Treatment Outcome

The aim of the study was to assess the relationship between procalcitonin (PCT) serum levels and acute ischemic stroke (AIS) in a Chinese sample. All consecutive patients with first-ever AIS between January 2012 and December 2013 were recruited to participate in the study. PCT levels and National Institutes of Health Stroke Scale scores were evaluated at the time of admission. Logistic regression analysis was used to evaluate the risk for stroke according to serum PCT levels. The results indicated that serum PCT levels were significantly higher in AIS patients as compared with normal controls (P<0.0001). PCT levels increased with increasing severity of stroke, as defined by the National Institutes of Health Stroke Scale score. After adjusting for all other possible covariates, PCT level was found to be associated with an increased risk for AIS, with an adjusted odds ratio of 2.244 (95% confidence interval 1.563-3.756, P<0.0001). On the basis of the receiver operating characteristic curve, the optimal cutoff value of serum PCT levels as an indicator for auxiliary diagnosis of AIS was projected to be 1.20 ng/ml, which yielded a sensitivity of 79.6% and a specificity of 72.1%, with the area under the curve at 0.801 (95% confidence interval 0.762-0.844). An elevated serum level of PCT was a novel, independent diagnostic marker of AIS in the Chinese sample. Further study is needed to confirm these results.

Topics: Aged; Biomarkers; Brain Ischemia; Calcitonin; Calcitonin Gene-Related Peptide; China; Female; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Protein Precursors; Risk; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Stroke

The aim of this study is to assess the prognostic value of systemic inflammation, as measured by the inflammatory biomarkers PCT and Hs-CRP, to predict the long-term mortality in ischemic stroke patients.. We prospectively studied 374 patients with ischemic stroke who were admitted within 24h after the onset of symptoms. Serum levels of PCT, Hs-CRP and NIH stroke scale (NIHSS) were measured at the time of admission. Clinical follow-up was performed at 1 year. The prognostic value of PCT to predict the mortality within one year was compared with Hs-CRP, NIHSS and with other known outcome predictors.. In the 64 non-survival patients, serum PCT levels were significantly (P<0.0001) higher compared with those in survival patients. Multivariate COX regression analysis showed that log-transformed PCT and Hs-CRP were independent mortality predictors with adjusted hazard ratio of 4.24 (95% confidence interval [CI], 2.42-6.30) and 15.37 (95% confidence interval [CI], 3.25-41.08). The area under the receiver operating characteristic curve of PCT and Hs-CRP were 0.89 (95% CI, 0.85-0.93) and 0.68 (95% CI, 0.59-0.77) for mortality, respectively.. Serum levels of PCT and HS-CRP at admission were independent predictor of long-term mortality after ischemic stroke in a Chinese sample.

Topics: Aged; Aged, 80 and over; Biomarkers; Brain Ischemia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Follow-Up Studies; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Severity of Illness Index; Stroke; Time Factors

We examined the value of serum procalcitonin (PCT), C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for predicting the survival of patients with early-onset stroke associated pneumonia (EOP). A total of 207 stroke patients were enrolled, and 91 developed EOP. Upon admission, serum PCT, CRP, sTREM-1 levels, clinical pulmonary infection score, and Acute Physiology and Chronic Health Evaluation II score were all significantly higher in patients with EOP than in those without EOP (P < 0.05). Of the 91 patients who developed EOP, 39 (42.9%) died (non-survivors) within 28 days. The Acute Physiology and Chronic Health Evaluation II score on admission was significantly higher in non-survivors than in survivors (P < 0.05). Serum PCT and sTREM-1 levels were slightly elevated on days 1, 3, and 5 in non-survivors and gradually decreased in survivors. Serum PCT, sTREM-1, and CRP levels were all significantly higher in non-survivors than in survivors on days 1, 3, and 5 (P < 0.05). The sensitivity and specificity of PCT for predicting the outcome of EOP were 84.6 and 71.2%, the sensitivity and specificity of sTREM-1 were 71.8 and 92.3%, and the sensitivity and specificity of sTREM-1 combined with PCT were 74.4 and 96.2%. Serum PCT combined with sTREM-1 accurately predicted the outcome of EOP patients, and dynamic monitoring of serum PCT and sTREM-1 levels is necessary.

Topics: Adult; Age of Onset; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Myeloid Cells; Pneumonia; Protein Precursors; Receptors, Immunologic; Stroke; Survival Rate; Young Adult

Early predictors for the development of stroke-associated infection may identify patients at high risk and reduce post-stroke infection and mortality.. In 383 prospectively enrolled acute stroke patients we assessed time point and type of post-stroke infections (i.e. pneumonia, urinary tract infection (UTI) other infection (OI)). Blood samples were collected on admission, and days 1, and 3 to assess white blood cells (WBC), monocytes, C-reactive protein (CRP), procalcitonin (PCT), and copeptin. To determine the magnitude of association with the development of infections, odds ratios (OR) were calculated for each prognostic blood marker. The discriminatory ability of different predictors was assessed, by calculating area under the receiver operating characteristic curves (AUC). Prognostic models including the three parameters with the best performance were identified.. Of 383 patients, 66 (17.2%) developed an infection after onset of stroke. WBC, CRP, copeptin and PCT were all independent predictors of any infection, pneumonia and UTI developed at least 24 hours after measurements. The combination of the biomarkers WBC, CRP and copeptin (AUC: 0.92) and WBC, CRP and PCT (AUC: 0.90) showed a better predictive accuracy concerning the development of pneumonia during hospitalization compared to each marker by itself (p-Wald <0.0001).. Among ischemic stroke patients, copeptin, PCT, WBC and CRP measured on admission were predictors of infection in general, and specifically for pneumonia and UTI within 5 days after stroke. The combination of these biomarkers improved the prediction of patients who developed an infection.

Topics: Aged; Area Under Curve; Biomarkers; Brain Ischemia; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glycopeptides; Humans; Infections; Inflammation; Male; Odds Ratio; Prognosis; Protein Precursors; Stroke

To investigate the significance of first determined contents of procalcitonin (PCT), C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) and the clinical pulmonary infection score (CPIS) in the detection of early-onset pneumonia (EOP) developed in patients suffering from stroke.. From June 2009 to June 2010, 244 stroke patients admitted to the emergency intensive care unit (EICU) in Shanghai Fifth People's Hospital were included in this prospective study. Patients were excluded if they were discharged or died in 24 hours of admission, or pneumonia was diagnosed at the admission. The serum levels of PCT, CRP and sTREM-1 were determined, and the CPIS was calculated in all patients on the day of admission.. Among all 244 stroke patients, EOP was diagnosed in 105 of them, and 74 developed severe EOP. The serum levels of PCT, CRP, sTREM-1 and the CPIS in patients with EOP were significantly higher than those in patients who did not develop EOP [PCT (μg/L): 4.20 (0.83,7.75) vs. 0.19 (0.12,0.41); CRP (mg/L): 56.0 (18.5,105.5) vs. 9.0 (7.0,15.0) ; sTREM-1 (ng/L): 56.0 (24.5,111.5) vs. 10.0 (8.0,16.0); CRIS: 4.0 (2.5,4.0) vs. 2.0 (1.0,2.0), all P<0.01], and the levels of PCT, CRP, sTREM-1 and the CPIS in patients with severe EOP were significantly higher than those in patients with mild EOP [PCT (μg/L): 6.10 (3.40,8.83) vs. 0.61 (0.42,1.67); CRP (mg/L): 80.5 (31.5,113.0) vs. 21.0 (12.0,43.0); sTREM-1 (ng/L): 89.0 (53.8,132.8) vs. 21.0 (14.0,43.0); CPIS: 4.0 (3.0,5.0) vs. 2.0 (2.0,3.0), all P<0.01]. The cutoff point, sensitivity and specificity of each indicator to predict EOP were 89.5% and 79.1% in PCT>0.43 μg/L, 78.1% and 78.4% in CRP>16 mg/L, 81.9% and 84.9% in sTREM-1>19 ng/L, 75.2% and 79.9% in CPIS>2. Using PCT>0.43 μg/L combined with CPIS>3 to predict EOP, the sensitivity and specificity reached 81.9% and 92.1% respectively. The cutoff point, sensitivity and specificity of indicators to identify severe EOP were 87.8% and 83.9% in PCT>2.15 μg/L, 70.3% and 77.4% in CRP>43 mg/L, 81.1% and 90.3% in sTREM-1>51 ng/L, 67.6% and 83.9% in CPIS>3. Using PCT>2.15 μg/L combined with sTREM-1>56 ng/L to predict severe EOP, the sensitivity and specificity reached 82.4% and 100.0% respectively.. The first PCT is an effective indicator to predict EOP. The first CPIS is an index for screening EOP. PCT combined with CPIS may improve the specificity to predict EOP. The first sTREM-1 is a good indicator to identify severe EOP. Combination of first PCT and sTREM-1 may greatly improve the specificity to predict severe EOP.

Topics: Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Protein Precursors; Stroke; Young Adult

Topics: Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Prognosis; Protein Precursors; Stroke; Time Factors