Skip to main content

Advertisement

SpringerLink
Log in

Procalcitonin is a Poor Predictor of Non-Infectious Fever in the Neurocritical Care Unit

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Fever is a common occurrence in the Neurocritical Care Unit (NCCU). It is reported that up to 50 % of these fevers are associated with a non-infectious source. As this is a diagnosis of exclusion, a complete fever evaluation must be done to rule out infection. Procalcitonin (PCT) has been identified as a possible biomarker to distinguish infectious from non-infectious etiologies of fever. We hypothesized that PCT could be used as a predictor of infectious fever in febrile patients with intracranial hemorrhage admitted to the NCCU.

Methods

A prospective observational cohort of patients admitted to a 12-bed NCCU in a tertiary-care university hospital from January 1, 2014, to October 1, 2014, was studied. Patients with intracranial hemorrhage (aneurismal subarachnoid hemorrhage, traumatic brain injury, intracerebral hemorrhage, or non-traumatic subdural hemorrhage) and fever defined as ≥101.4 °F were included. All patients had a urinalysis, chest X-ray, two sets of blood cultures, and PCT as part of their fever evaluation. Patients also had urine, sputum, CSF cultures, and Clostridium difficile toxin PCR as clinically indicated. Patients with incomplete fever evaluations were excluded.

Results

Seventy-three patients met inclusion criteria: 36 had infections identified and 37 did not. Type of intracranial hemorrhage was similar between groups. For those with identified infection, median PCT was 0.15 ng/mL (IQR 0.06–0.5 ng/mL). For those without identified infection, median PCT was 0.09 ng/mL (IQR 0.05–0.45 ng/mL), p = 0.30. Analyzing subgroups of intracranial hemorrhage patients revealed no group with a significant difference in PCT values. Patients with identified infection did have higher white blood cell counts (median 14.1 × 109/L (11.6–17.4 × 109/L) compared to those without identified infection 12 × 109/L (9.9–14.1 × 109/L), p = 0.02.

Conclusion

Among patients with intracranial hemorrhage, PCT did not differentiate infectious fever from non-infectious fever.

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. Rabinstein AA, Sandhu K. Non-infectious fever in the neurological intensive care unit: incidence, causes and predictors. J Neurol Neurosurg Psychiatry. 2007;78(11):1278–80.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Commichau C, Scarmeas N, Mayer SA. Risk factors for fever in the neurologic intensive care unit. Neurology. 2003;60(5):837–41.

    Article  PubMed  Google Scholar 

  3. Thompson HJ, Pinto-Martin J, Bullock MR. Neurogenic fever after traumatic brain injury: an epidemiological study. J Neurol Neurosurg Psychiatry. 2003;74(5):614–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sung CY, Lee TH, Chu NS. Central hyperthermia in acute stroke. Eur Neurol. 2009;62(2):86–92.

    Article  PubMed  Google Scholar 

  5. Buratti T, et al. Plasma levels of procalcitonin and interleukin-6 in acute myocardial infarction. Inflammation. 2001;25(2):97–100.

    Article  CAS  PubMed  Google Scholar 

  6. Castelli GP, et al. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care. 2004;8(4):R234–42.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Harbarth S, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001;164(3):396–402.

    Article  CAS  PubMed  Google Scholar 

  8. Matzaraki V, et al. Evaluation of serum procalcitonin and interleukin-6 levels as markers of liver metastasis. Clin Biochem. 2007;40(5–6):336–42.

    Article  CAS  PubMed  Google Scholar 

  9. Al-Nawas B, Krammer I, Shah PM. Procalcitonin in diagnosis of severe infections. Eur J Med Res. 1996;1(7):331–3.

    CAS  PubMed  Google Scholar 

  10. Mann EA, Wood GL, Wade CE. Use of procalcitonin for the detection of sepsis in the critically ill burn patient: a systematic review of the literature. Burns. 2011;37(4):549–58.

    Article  PubMed  Google Scholar 

  11. Muller B, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000;28(4):977–83.

    Article  CAS  PubMed  Google Scholar 

  12. Wanner GA, et al. Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. Crit Care Med. 2000;28(4):950–7.

    Article  CAS  PubMed  Google Scholar 

  13. Rudy T, Pathogenesis of fever associated with cerebral trauma and intracranial hemorrhage. In: Cox B editor. Thermoregulatory mechanisms and therapeutic implications, Vol. 4th. International Symposium on the Pharmacology of Thermoregulation. Switzerland; 1980.

  14. Dietrich WD, et al. Delayed posttraumatic brain hyperthermia worsens outcome after fluid percussion brain injury: a light and electron microscopic study in rats. Neurosurgery. 1996;38(3):533–41 discussion 541.

    CAS  PubMed  Google Scholar 

  15. Suprin E, et al. Procalcitonin: a valuable indicator of infection in a medical ICU? Intensive Care Med. 2000;26(9):1232–8.

    Article  CAS  PubMed  Google Scholar 

  16. Ugarte H, et al. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med. 1999;27(3):498–504.

    Article  CAS  PubMed  Google Scholar 

  17. Kumar A, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.

    Article  PubMed  Google Scholar 

  18. Ferrer R, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42(8):1749–55.

    Article  CAS  PubMed  Google Scholar 

  19. Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother. 2011;66(Suppl 2):33–40.

    Google Scholar 

  20. Schuetz P, et al. Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients. Crit Care. 2013;17(3):R115.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Friend KE, et al. Procalcitonin elevation suggests a septic source. Am Surg. 2014;80(9):906–9.

    PubMed  Google Scholar 

  22. Liu HH, et al. Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either Gram-negative or Gram-positive bacteria. Ir J Med Sci. 2016. doi:10.1007/s11845-016-1457-z.

    Google Scholar 

  23. Guo SY, et al. Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis. Am J Med Sci. 2015;349(6):499–504.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Festic E, et al. The utility of serum procalcitonin in distinguishing systemic inflammatory response syndrome from infection after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2014;20(3):375–81.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pulmonary and Critical Care Medicine, Tulane University, 1430 Tulane Avenue, New Orleans, LA, 70115, USA

    Karin Halvorson

  2. Department of Pulmonary and Critical Care Medicine, North Shore Medical Center, 81 Highland Drive, Salem, MA, 01970, USA

    Sameer Shah

  3. Department of Neurology and Neurosurgery, Warren Alpert Medical School, Brown University, 593 Eddy Street, Providence, RI, 02903, USA

    Corey Fehnel, Bradford Thompson, N. Stevenson Potter & Linda Wendell

  4. Department of Pulmonary and Critical Care Medicine, Warren Alpert Medical School, Brown University, 593 Eddy Street, Providence, RI, 02903, USA

    Mitchell Levy

Authors
  1. Karin Halvorson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sameer Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corey Fehnel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bradford Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Stevenson Potter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mitchell Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Linda Wendell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karin Halvorson.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Halvorson, K., Shah, S., Fehnel, C. et al. Procalcitonin is a Poor Predictor of Non-Infectious Fever in the Neurocritical Care Unit. Neurocrit Care 27, 237–241 (2017). https://doi.org/10.1007/s12028-016-0337-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-016-0337-8

Keywords

Search

Navigation