Abstract
Objective. Determine the potential of procalcitonin (PCT) to predict neurological outcome after hypothermia treatment following cardiac arrest. Methods. Retrospective analysis of patient data over a 2-year period. Mortality and neurological outcome of survivors were determined 6 months after cardiac arrest using the Cerebral Performance Category (CPC) score. Results. Data from 53 consecutive patients were analyzed. Median age was 63 (54–71) and 79% were male. Twenty-seven patients had good outcome (CPC ≤ 2) whereas 26 had severe neurological sequelae or died (CPC 3–5). At 48 h, after regaining normothermia, PCT was significantly higher in patients with bad outcome compared to those with good outcome: 3.38 (1.10–24.48) versus 0.28 (0–0.75) ng/mL (P < 0.001). PCT values correlated with bad neurological outcome (r = 0.54, P = 0.00004) and predicted outcome with an area under the curve of 0.84 (95% CI 0.73–0.96). A cutoff point of 1 ng/mL provided a sensitivity of 85% and a specificity of 81%. Above a PCT level of 16 ng/mL, no patient regained consciousness. PCT provided an additive value over simplified acute physiology score II. Conclusions. PCT might be an ancillary marker for outcome prediction after cardiac arrest treated by induced hypothermia.
Highlights
Successful cardiopulmonary resuscitation after sudden cardiac arrest (CA) is followed by the early development of a systemic inflammatory response syndrome, characterized by an increase of serum markers of inflammation including C-reactive protein (CRP), tumor-necrosis factor alpha, interleukin-6, and procalcitonin (PCT) [1].In patients with sepsis, PCT has been shown to be a specific marker of bacterial infection, a valuable tool to guide antibiotic therapy, and a predictor of sepsis-associated mortality [2,3,4]
This cohort study was conducted in an 18-bed mixed intensive care unit (ICU) of an academic tertiary care centre linked to the national institute for cardiosurgery and interventional cardiology of Luxembourg
Between April 2008 and June 2010, 68 consecutive adult patients subjected to Mild therapeutic hypothermia (MTH) after successful cardiopulmonary resuscitation were admitted to our ICU
Summary
Successful cardiopulmonary resuscitation after sudden cardiac arrest (CA) is followed by the early development of a systemic inflammatory response syndrome, characterized by an increase of serum markers of inflammation including C-reactive protein (CRP), tumor-necrosis factor alpha, interleukin-6, and procalcitonin (PCT) [1].In patients with sepsis, PCT has been shown to be a specific marker of bacterial infection, a valuable tool to guide antibiotic therapy, and a predictor of sepsis-associated mortality [2,3,4]. During the early postresuscitation phase following cardiac arrest the diagnostic value of PCT to assess infection is poor [5, 6]. Mild therapeutic hypothermia (MTH) has been shown to improve neurologic outcome after CA in several studies but may modulate the serum PCT concentration and its utility as an outcome-predictive marker [9,10,11]. PCT values of 0,5 ng/mL one day after hospitalization were found to be highly predictive for bad neurological outcome in patients after CA without the use of MTH [7]. In a second study, PCT values 24 hours after ICU admission varied largely when comparing patients submitted to MTH to normothermic patients [12]. No differences between the groups were found when the PCT measurements were repeated 120 hours after ICU admission
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