Skip to main content
SpringerLink
Log in

Early Systemic Procalcitonin Levels in Patients with Aneurysmal Subarachnoid Hemorrhage

  • ORIGINAL ARTICLE
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Early (≤24 h) systemic procalcitonin (PCT) levels are predictive for unfavorable neurological outcome in patients after out-of-hospital cardiac arrest (OHCA). Subarachnoid hemorrhage (SAH) due to aneurysm rupture might lead to a cerebral perfusion stop similar to OHCA. The current study analyzed the association of early PCT levels and outcome in patients after SAH.

Methods

Data from 109 consecutive patients, admitted within 24 h after SAH, were analyzed. PCT levels were measured within 24 h after ictus. Clinical severity was determined using the World Federation of Neurological Societies (WFNS) scale and dichotomized into severe (grade 4–5) and non-severe (1–3). Neurological outcome after 3 months was assessed by the Glasgow outcome scale and dichotomized into unfavorable (1–3) and favorable (4–5). The predictive value was assessed using receiver operating curve (ROC) analysis.

Results

Systemic PCT levels were significantly higher in patients with severe SAH compared to those with non-severe SAH: 0.06 ± 0.04 versus 0.11 ± 0.11 μg/l (median ± interquartile range; p < 0.01). Patients with unfavorable outcome had significantly higher PCT levels compared to those with favorable outcome 0.09 ± 0.13 versus 0.07 ± 0.15 ng/ml (p < 0.01). ROC analysis showed an area under the curve of 0.66 (p < 0.01) for PCT, which was significantly lower than that of WFNS with 0.83 (p < 0.01).

Conclusions

Early PCT levels in patients with SAH might reflect the severity of the overall initial stress response. However, the predictive value is poor, especially compared to the reported predictive values in patients with OHCA. Early PCT levels might be of little use in predicting neurological outcome after SAH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Muroi C, Seule M, Mishima K, Keller E. Novel treatments for vasospasm after subarachnoid hemorrhage. Curr Opin Crit Care. 2012;18:119–26.

    Article  PubMed  Google Scholar 

  2. Macdonald RL, Higashida RT, Keller E, et al. Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol. 2011;10:618–25.

    Article  CAS  PubMed  Google Scholar 

  3. Sehba FA, Pluta RM, Zhang JH. Metamorphosis of subarachnoid hemorrhage research: from delayed vasospasm to early brain injury. Mol Neurobiol. 2011;43:27–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Caner B, Hou J, Altay O, Fuj M 2nd, Zhang JH. Transition of research focus from vasospasm to early brain injury after subarachnoid hemorrhage. J Neurochem. 2012;123(Suppl 2):12–21.

    Article  CAS  PubMed  Google Scholar 

  5. Fries M, Kunz D, Gressner AM, Rossaint R, Kuhlen R. Procalcitonin serum levels after out-of-hospital cardiac arrest. Resuscitation. 2003;59:105–9.

    Article  CAS  PubMed  Google Scholar 

  6. Hayashida H, Kaneko T, Kasaoka S, et al. Comparison of the predictability of neurological outcome by serum procalcitonin and glial fibrillary acidic protein in postcardiac-arrest patients. Neurocrit Care. 2010;12:252–7.

    Article  CAS  PubMed  Google Scholar 

  7. Stammet P, Devaux Y, Azuaje F, et al. Assessment of procalcitonin to predict outcome in hypothermia-treated patients after cardiac arrest. Crit Care Res Pract. 2011;2011:631062.

    PubMed Central  PubMed  Google Scholar 

  8. Muroi C, Hugelshofer M, Seule M, et al. Correlation between systemic inflammatory parameter, occurrence of delayed neurological deficits and outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2013;72:367–75.

    Article  PubMed  Google Scholar 

  9. Oconnor E, Venkatesh B, Mashongonyika C, Lipman J, Hall J, Thomas P. Serum procalcitonin and C-reactive protein as markers of sepsis and outcome in patients with neurotrauma and subarachnoid haemorrhage. Anaesth Intensive Care. 2004;32:465–70.

    CAS  PubMed  Google Scholar 

  10. Drake CG. Report of World Federation of Neurological Surgeons Committee On a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988;68:985–6.

    Google Scholar 

  11. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6:1–9.

    CAS  PubMed  Google Scholar 

  12. Lerch C, Yonekawa Y, Muroi C, Bjeljac M, Keller E. Specialized neurocritical care, severity grade, and outcome of patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2006;5:85–92.

    Article  PubMed  Google Scholar 

  13. Keller E, Krayenbuhl N, Bjeljac M, Yonekawa Y. Cerebral vasospasm: results of a structured multimodal treatment. Acta Neurochir Suppl. 2005;94:65–73.

    Article  CAS  PubMed  Google Scholar 

  14. Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med. 2008;36:941–52.

    Article  CAS  PubMed  Google Scholar 

  15. Seule MA, Muroi C, Mink S, Yonekawa Y, Keller E. Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm. Neurosurgery. 2009;64:86–92.

    Article  PubMed  Google Scholar 

  16. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–74.

    Article  Google Scholar 

  17. Tong HS, Liu YS, Wen Q, Tang YQ, Yuan FF, Su L. Serum procalcitonin predicting mortality in exertional heatstroke. Emerg Med J. 2012;29:113–7.

    Article  PubMed  Google Scholar 

  18. Adrie C, Adib-Conquy M, Laurent I, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation. 2002;106:562–8.

    Article  PubMed  Google Scholar 

  19. Adrie C, Laurent I, Monchi M, Cariou A, Dhainaou JF, Spaulding C. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care. 2004;10:208–12.

    Article  PubMed  Google Scholar 

  20. Fries M, Stoppe C, Brucken D, Rossaint R, Kuhlen R. Influence of mild therapeutic hypothermia on the inflammatory response after successful resuscitation from cardiac arrest. J Crit Care. 2009;24:453–7.

    Article  PubMed  Google Scholar 

  21. Nornes H, Magnaes B. Intracranial pressure in patients with ruptured saccular aneurysm. J Neurosurg. 1972;36:537–47.

    Article  CAS  PubMed  Google Scholar 

  22. Grote E, Hassler W. The critical first minutes after subarachnoid hemorrhage. Neurosurgery. 1988;22:654–61.

    Article  CAS  PubMed  Google Scholar 

  23. Kamiya K, Kuyama H, Symon L. An experimental study of the acute stage of subarachnoid hemorrhage. J Neurosurg. 1983;59:917–24.

    Article  CAS  PubMed  Google Scholar 

  24. Asano T, Sano K. Pathogenetic role of no-reflow phenomenon in experimental subarachnoid hemorrhage in dogs. J Neurosurg. 1977;46:454–66.

    Article  CAS  PubMed  Google Scholar 

  25. Dorsch N, Branston NM, Symon L, Jakubowski J. Intracranial pressure changes following primate subarachnoid haemorrhage. Neurol Res. 1989;11:201–4.

    CAS  PubMed  Google Scholar 

  26. Jain R, Deveikis J, Thompson BG. Management of patients with stunned myocardium associated with subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2004;25:126–9.

    PubMed  Google Scholar 

  27. Macdonald RL, Pluta RM, Zhang JH. Cerebral vasospasm after subarachnoid hemorrhage: the emerging revolution. Nat Clin Pract Neurol. 2007;3:256–63.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland

    Carl Muroi, Johanna B. Lemb, Michael Hugelshofer, Martin Seule & Emanuela Keller

  2. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Carl Muroi

  3. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland

    David Bellut

Authors
  1. Carl Muroi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johanna B. Lemb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Hugelshofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Seule
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Bellut
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emanuela Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carl Muroi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muroi, C., Lemb, J.B., Hugelshofer, M. et al. Early Systemic Procalcitonin Levels in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 21, 73–77 (2014). https://doi.org/10.1007/s12028-013-9844-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-013-9844-z

Keywords

Search

Navigation