Abstract
IntroductionAcute-phase proteins, such as procalcitonin (PCT), C-reactive protein (CRP) and albumin, may relate with course and outcome in status epilepticus (SE), as seizures bring about inflammation, changes of cytokine levels and blood–brain barrier breakdown. We aimed to determine the predictive value of serum levels of PCT at SE onset for the emergence of infections and unfavorable outcome in adult patients with SE. Furthermore, we sought to compare the predictive value of PCT, CRP and albumin for death.MethodsThis observational cohort study was performed in the intensive care units of the University Hospital Basel (Switzerland), a university-affiliated tertiary care center. Adult patients with SE admitted from 2005 to 2012 were included. Serum levels of PCT, CRP and albumin were assessed at SE onset. Unfavorable outcome (i.e., death and a Glasgow Outcome Score of 1 to 3) during hospital stay and mortality after 30 days were considered the primary and infections as the secondary outcome measures.ResultsIn 91 SE patients, mortality was 23.1 % during hospital stay and at 30-days follow-up. Infections emerged in 30.8 % of patients. In the multivariable analysis, PCT predicted unfavorable outcome independently from possible confounders such as acute etiology, infections during SE, the Charlson Comorbidity Index, and the Status Epilepticus Severity Score (hazard ratio 1.44 per every increasing ug/L, 95 % confidence interval 1.11-1.87). Additional multivariable analysis including serum levels of PCT, CRP and albumin revealed PCT as the only biomarker independently associated with an increased hazard for unfavorable outcome. PCT levels at SE onset were not related to infections during SE.ConclusionsSerum PCT levels measured at SE onset are independently associated with unfavorable outcome but do not predict the emergence of infections during SE. Procalcitonin may increase the predictive value of clinical scoring systems allowing for rapid risk stratification early in the course of SE.
Highlights
Acute-phase proteins, such as procalcitonin (PCT), C-reactive protein (CRP) and albumin, may relate with course and outcome in status epilepticus (SE), as seizures bring about inflammation, changes of cytokine levels and blood–brain barrier breakdown
Sutter et al Critical Care (2015) 19:361 prognosis would profit from early escalation of antiepileptic treatment, intensified continuous video-EEG monitoring, or neuroprotective measures, especially as patients with more benign types of SE are at risk of being overtreated
The aim of this study was to determine the predictive value of serum levels of PCT at SE onset for the emergence of infections and unfavorable outcome as determined by the Glasgow outcome scale (GOS) in adult patients with SE
Summary
Acute-phase proteins, such as procalcitonin (PCT), C-reactive protein (CRP) and albumin, may relate with course and outcome in status epilepticus (SE), as seizures bring about inflammation, changes of cytokine levels and blood–brain barrier breakdown. A study of serum concentrations of acute-phase proteins measured early in SE revealed an independent association between albumin serum levels and treatment refractory SE as well as death, while C-reactive protein (CRP) levels were inconsistent [8]. Another promising acute-phase protein is procalcitonin (PCT), a prepropeptide precursor of the thyroid hormone calcitonin secreted from the thyroid parafollicular cells, which increases under various inflammatory conditions, most notably with bacterial infections and sepsis [9, 10]. Analyses of the diagnostic and prognostic yield of PCT in patients with SE are scarce and restricted to the diagnosis of infections emerging during SE in small numbers of patients [15]
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