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VOLUME 24 , ISSUE 5 ( May, 2020 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Is Procalcitonin a Marker of Neurologic Outcome or Early Infection in Patients Treated with Targeted Temperature Management?

Ciler Zincircioglu, Tunzala Yavuz, Aykut Sarıtaş, Meltem Çakmak, Işıl Köse Güldoğan, Uğur Uzun, Nimet Şenoğlu

Keywords : Cardiac arrest, Patient outcome, Procalcitonin, Resuscitation, Targeted temperature management

Citation Information : Zincircioglu C, Yavuz T, Sarıtaş A, Çakmak M, Güldoğan IK, Uzun U, Şenoğlu N. Is Procalcitonin a Marker of Neurologic Outcome or Early Infection in Patients Treated with Targeted Temperature Management?. Indian J Crit Care Med 2020; 24 (5):327-331.

DOI: 10.5005/jp-journals-10071-23418

License: CC BY-NC 4.0

Published Online: 28-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Objectives: Although high procalcitonin (PCT) levels are associated with poor neurological outcomes and increased mortality rates in patients treated with targeted temperature management (TTM) in the postcardiac arrest (CA) period, there are limited data about the correlation between PCT levels and infection. The aim of our study was to assess the relationship of PCT levels in the first 48 hours with early period infections, late period neurological prognosis, and mortality in patients treated with TTM after CA. Materials and methods: Serum PCT was measured on admission days 1 and 2. The early onset infection diagnosis before the seventh day in the intensive care unit (ICU) was made according to the criteria of infection centers for disease control and prevention. Mortality and neurologic outcomes were assessed 90 days after CA according to cerebral performance category (CPC) score. Results: There was no statistically significant correlation between early period infection diagnosis and PCT levels at the time of admission, 24th, and 48th hours. Patients with poor neurologic outcomes on the 90th day had significantly high PCT levels at 24 (p = 0.044) and 48 hours (p = 0.004). There was no statistically significant correlation between admission PCT levels and neurological prognosis. While the correlation between mortality and PCT levels at 24 (p = 0.049) and 48 (p = 0.004) hours was significantly high, no statistically significant correlation was found between admission PCT levels and mortality. Conclusion: In patients treated with TTM after CA, increased PCT levels were significantly correlated with poor neurologic outcomes and mortality. However, the elevated PCT levels were not significantly correlated with early period infections.


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  1. Schenone AL, Cohen A, Patarroyo G, Harper L, Wang X, Shishehbor MH, et al. Therapeutic hypothermia after cardiac arrest: a systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature. Resuscitation 2016;108:102–110. DOI: 10.1016/j.resuscitation.2016.07.238.
  2. Geurts M, Macleod MR, Kollmar R, Kremer PH, Van der Worp HB. Therapeutic hypothermia and the risk of infection: a systematic review and meta-analysis. Crit Care Med 2014;42(2):231–242. DOI: 10.1097/CCM.0b013e3182a276e8.
  3. Zandbergen EG, Hijdra A, Koelman JH, Hart AA, Vos PE, Verbeek MM, et al. Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 2006;66(1):62–68. DOI: 10.1212/01.wnl.0000191308.22233.88.
  4. Annborn M, Dankiewicz J, Erlinge D, Hertel S, Rundgren M, Smith JG, et al. Procalcitonin after cardiac arrest–an indicator of severity of illness, ischemia-reperfusion injury and outcome. Resuscitation 2013;84(6):782–787. DOI: 10.1016/j.resuscitation.2013.01.004.
  5. Meisner M. Pathobiochemistry and clinical use of procalcitonin. Clin Chim Acta 2002;323(1-2):17–29. DOI: 10.1016/s0009-8981(02)00101-8.
  6. Müller B, White JC, Nylén ES, Snider RH, Becker KL, Habener JF. Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. The J Clin Endocrinol Metab 2001;86(1):396–404. DOI: 10.1210/jcem.86.1.7089.
  7. De Jong E, Van Oers JA, Beishuizen A, Vos P, Vermeijden WJ, Haas LE, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. The Lancet Infect Dis 2016;16(7):819–827. DOI: 10.1016/S1473-3099(16)00053-0.
  8. 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(3):208–212. DOI: 10.1097/01.ccx.0000126090.06275.fe.
  9. Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation 2002;106(5):562–568. DOI: 10.1161/01.cir.0000023891.80661.ad.
  10. Engel H, Ben Hamouda N, Portmann K, Delodder F, Suys T, Feihl F, et al. Serum procalcitonin as a marker of post-cardiac arrest syndrome and long-term neurological recovery, but not of early-onset infections, in comatose post-anoxic patients treated with therapeutic hypothermia. Resuscitation 2013;84(6):776–781. DOI: 10.1016/j.resuscitation.2013.01.029.
  11. Schuetz P, Affolter B, Hunziker S, Winterhalder C, Fischer M, Balestra GM, et al. Serum procalcitonin, C-reactive protein and white blood cell levels following hypothermia after cardiac arrest: A retrospective cohort study. Eur J Clin Invest 2010;40(4):376–381. DOI: 10.1111/j.1365-2362.2010.02259.x.
  12. Jannett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975(7905):480–487. DOI: 10.1016/s0140-6736(75) 92830-5.
  13. Becker KL, Nylen ES, White JC, Muller B, Snider Jr, RH. Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89(4):1512–1525. DOI: 10.1210/jc.2002- 021444.
  14. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013;13(5):426–435. DOI: 10.1016/S1473-3099(12)70323-7.
  15. Sponholz C, Sakr Y, Reinhart K, Brunkhorst F. Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Crit Care 2006;10(5):R145. DOI: 10.1186/cc5067.
  16. Varon J, Anda-Izaguirre D, Fernandez-Hernandez S, Padilla Ramos A, Ocegueda-Pacheco C, Herrero SM. Procalcitonin levels as predictors of neurological outcome in patients with cardiac arrest treated with mild therapeutic hypothermia: a retrospective study. Critical Care Shock 2015;18(4). DOI: https://doi.org/10.1016/j.resuscitation.2014.03.255.
  17. Oppert M, Reinicke A, Müller C, Barckow D, Frei U, Eckardt KU. Elevations in procalcitonin but not C-reactive protein are associated with pneumonia after cardiopulmonary resuscitation. Resuscitation 2002;53(2):167–170. DOI: 10.1016/s0300-9572(02)00008-4.
  18. Mongardon N, Lemiale V, Perbet S, Dumas F, Legriel S, Guérin S, et al. Value of procalcitonin for diagnosis of early onset pneumonia in hypothermia-treated cardiac arrest patients. Intensive Care Med 2010;36(1):92–99. DOI: 10.1007/s00134-009-1681-3.
  19. Bro-Jeppesen J, Kjaergaard J, Wanscher M, Nielsen N, Friberg H, Bjerre M, et al. Systemic inflammatory response and potential prognostic implications after out-of-hospital cardiac arrest: a substudy of the target temperature management trial. Crit Care Med 2015;43(6): 1223–1232. DOI: 10.1097/CCM.0000000000000937.
  20. Leão RN, Ávila P, Cavaco R, Germano N, Bento L. Therapeutic hypothermia after cardiac arrest: outcome predictors. Rev Bras Ter Intensiva 2015;27(4):322–332. DOI: 10.5935/0103-507X.20150056.
  21. Nolan JP, Soar J. Postresuscitation care: entering a new era. Curr Opin Crit Care 2010;16(3):216–222. DOI: 10.1097/MCC.0b013e3283383dca.
  22. Oddo M, Rossetti AO. Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care 2011;17(3):254–259. DOI: 10.1097/MCC.0b013e328344f2ae.
  23. Cronberg T, Rundgren M, Westhall E, Englund E, Siemund R, Rosen I, et al. Neuron-specific enolase correlates with other prognostic markers after cardiac arrest. Neurology 2011;77(7):623–630. DOI: 10.1212/WNL.0b013e31822a276d.
  24. Ok G, Aydin D, Erbüyün K, Gürsoy C, Taneli F, Bilge S, et al. Neurological outcome after cardiac arrest: a prospective study of the predictive ability of prognostic biomarkers neuron-specific enolase, glial fibrillary acidic protein, S-100B, and procalcitonin. Turkish J Med Sci 2016;46(5):1459–1468. DOI: 10.3906/sag-1503-64.
  25. Polderman KH, Varon J. Cool hemodynamics–the intricate interplay between therapeutic hypothermia and the post-cardiac arrest syndrome. Resuscitation 2014;85(8):975–976. DOI: 10.1016/j.resuscitation.2014.06.002.
  26. Shin H, Kim JG, Kim W, Lim TH, Jang BH, Cho Y, et al. Procalcitonin as a prognostic marker for outcomes in post-cardiac arrest patients: a systematic review and meta-analysis. Resuscitation 2019;138(5): 160–167. DOI: 10.1016/j.resuscitation.2019.02.041.
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