Biomarker Used for Febrile Intracranial Hemorrhage Patients

Procalcitonin (PCT) is a biomarker that exhibits greater specificity than other proinflammatory markers, such as cytokines, in identifying patients with sepsis and can be used in the diagnosis of bacterial infections.

Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue itself, a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma.

Scientists at North Shore University Hospital (Manhasset, NY, USA) and their colleagues enrolled in a prospective observational study 104 patients with intracranial hemorrhage (ICH) and fever above 38.3 ⁰C admitted to Intensive Care Units (ICUs) of a tertiary care hospital. PCT was measured on day one (PCT1) of fever and 48-72h later (PCT2). Patients were determined to have an infection (pneumonia, urinary tract infection or bacteremia) based on cultures, imaging and clinical impression of treating clinicians.

The team used statistical analysis that indicated significant mean differences in PCT1 between patients with no, probable and definite infection. Patients with probable infection had the highest mean PCT1 and those with definite infection had higher PCT2. Additional analyses of univariable mean differences showed a mean PCT1 that was significantly higher in the probable-infection group compared with the no-infection group and mean PCT that was significantly higher at both time points in the definite-infection group compared with the no-infection group; however, there were no significant differences between the probable and definite-infection group.

The authors concluded that PCT levels were higher in patients with ICH and infections, and may be a useful marker to differentiate between infectious and noninfectious etiologies of fevers in these patients. Further studies including randomized control trials will help in establishing the utility of this marker in optimal management of febrile patients with ICH. The study was published on May 29, 2018, in the journal World Neurosurgery.

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