Procalcitonin levels among patients with fever secondary to intracerebral hemorrhage and severe infection. A cross-sectional study

ABSTRACT BACKGROUND: Making the differential diagnosis between central fever and infectious fever is critically important among intracerebral hemorrhage patients followed up in intensive care units (ICUs). Serum procalcitonin (PCT) has been found to be a promising biomarker for the initial diagnosis of infection, even before culturing results. OBJECTIVES: To investigate the relationship between PCT and both fever etiologies and C-reactive protein (CRP) levels among critically ill patients with suspected intracerebral hemorrhage. DESIGN AND SETTING: Cross-sectional study in a public university hospital in Elazig, Turkey. METHODS: ICU patients diagnosed with intracerebral hemorrhage and normal procalcitonin levels were included in this study. From clinical assessments and cultures, they were classified as presenting either infectious or central fever. The sensitivity and specificity of PCT and CRP for predicting infection were calculated using a receiver operating characteristic (ROC) curve. RESULTS: There were 98 ICU patients with diagnoses of intracerebral hemorrhage. The median (interquartile range) PCT levels of patients with infectious and central fever were 4 (0.9-11) and 0.1 (0.1-0.4) ng/ml, respectively, with a statistically significant intergroup difference (P < 0.001). The areas under the ROC curve for predicting infectious or central fever PCT and CRP were 0.958 (P < 0.001) and 0.816 (P < 0.001), respectively. A statistically significant positive correlation was detected between PCT and CRP levels in patients with infectious fever (rho: 0.461; P = 0.003), but not in patients with central fever. CONCLUSIONS: PCT can possibly be used as a biomarker to differentiate between infectious and central fever among ICU patients.

摘要

背景：针对入住重症监护病房（Intensive Care Unit, ICU）的脑出血患者，鉴别中枢性发热与感染性发热具有重要临床意义。研究显示，血清降钙素原（procalcitonin, PCT）是一种极具潜力的感染早期诊断生物标志物，甚至可在微生物培养结果回报前辅助诊断。

目的：探讨疑似脑出血重症患者的血清PCT水平与发热病因及C反应蛋白（C-reactive protein, CRP）水平之间的关联。

设计与研究场所：本研究为横断面研究，实施于土耳其埃拉泽格的一所公立大学医院。

方法：本研究纳入经确诊为脑出血且血清PCT水平正常的ICU患者。通过临床评估与微生物培养结果，将患者划分为感染性发热组与中枢性发热组。采用受试者工作特征（Receiver Operating Characteristic, ROC）曲线，计算PCT与CRP预测感染发生的灵敏度与特异度。

结果：本研究共纳入98名确诊脑出血的ICU患者。感染性发热组与中枢性发热组患者的PCT中位数（四分位数间距）分别为4（0.9~11）ng/ml与0.1（0.1~0.4）ng/ml，组间差异具有显著统计学意义（P < 0.001）。PCT与CRP鉴别感染性与中枢性发热的ROC曲线下面积分别为0.958（P < 0.001）与0.816（P < 0.001）。感染性发热患者的PCT与CRP水平呈显著正相关（ρ=0.461；P=0.003），而中枢性发热患者未观察到该相关性。

结论：血清PCT可作为鉴别ICU患者感染性发热与中枢性发热的潜在生物标志物。