BACKGROUND: Patients with extensive brain infarcts are at increased risk for stroke-associated respiratory tract infections (SARTI), which cause worse outcome. The benefit of general antibiotic prophylaxis is controversial. Early diagnosis of SARTI may improve patient selection for antimicrobial therapy. Procalcitonin (PCT) is widely recognized as serum marker for bacterial infections. Its diagnostic value with respect to SARTI has not been assessed systematically. METHODS: Serum PCT levels were analyzed in ischemic stroke patients (n = 50) at day 1 (d1) and day 4 (d4) after stroke onset. PCT test performance was assessed by receiver operator characteristics (ROC) curve analysis. Multivariable logistic regression analysis was applied to identify early predictors for SARTI. RESULTS: Higher d4 serum PCT levels were associated with SARTI; ROC curve analysis revealed an area under the curve (AUC) of 0.79 (95%-confidence interval (CI) 0.61-0.96). A 0.25-ng/ml cutoff resulted in a test sensitivity and specificity of 42 and 96%, respectively. Positive (LR+) and negative (LR-) likelihood ratios were 10.8 and 0.6, respectively. In predicting SARTI, multivariable logistic regression analysis controlling for infarct volume ruled out an independent explanatory effect of serum PCT. Greater infarct volume (odds ratio (OR) 1.06, 95%-CI 1.02-1.1) prevailed as independent SARTI-predictor. CONCLUSIONS: In the absence of clinical signs, post-stroke screening for SARTI using serum PCT levels is not useful since test sensitivity is low. If the clinical suspicion for SARTI is strong, serum PCT-testing (>0.25 ng/ml) may improve diagnostic accuracy by improving specificity.
BACKGROUND:Patients with extensive brain infarcts are at increased risk for stroke-associated respiratory tract infections (SARTI), which cause worse outcome. The benefit of general antibiotic prophylaxis is controversial. Early diagnosis of SARTI may improve patient selection for antimicrobial therapy. Procalcitonin (PCT) is widely recognized as serum marker for bacterial infections. Its diagnostic value with respect to SARTI has not been assessed systematically. METHODS: Serum PCT levels were analyzed in ischemic strokepatients (n = 50) at day 1 (d1) and day 4 (d4) after stroke onset. PCT test performance was assessed by receiver operator characteristics (ROC) curve analysis. Multivariable logistic regression analysis was applied to identify early predictors for SARTI. RESULTS: Higher d4 serum PCT levels were associated with SARTI; ROC curve analysis revealed an area under the curve (AUC) of 0.79 (95%-confidence interval (CI) 0.61-0.96). A 0.25-ng/ml cutoff resulted in a test sensitivity and specificity of 42 and 96%, respectively. Positive (LR+) and negative (LR-) likelihood ratios were 10.8 and 0.6, respectively. In predicting SARTI, multivariable logistic regression analysis controlling for infarct volume ruled out an independent explanatory effect of serum PCT. Greater infarct volume (odds ratio (OR) 1.06, 95%-CI 1.02-1.1) prevailed as independent SARTI-predictor. CONCLUSIONS: In the absence of clinical signs, post-stroke screening for SARTI using serum PCT levels is not useful since test sensitivity is low. If the clinical suspicion for SARTI is strong, serum PCT-testing (>0.25 ng/ml) may improve diagnostic accuracy by improving specificity.
Authors: Mirjam Christ-Crain; Daiana Jaccard-Stolz; Roland Bingisser; Mikael M Gencay; Peter R Huber; Michael Tamm; Beat Müller Journal: Lancet Date: 2004-02-21 Impact factor: 79.321
Authors: Christian Meisel; Jan M Schwab; Konstantin Prass; Andreas Meisel; Ulrich Dirnagl Journal: Nat Rev Neurosci Date: 2005-10 Impact factor: 34.870
Authors: Andreas Hug; Alexander Dalpke; Nina Wieczorek; Thomas Giese; Alexander Lorenz; Gerd Auffarth; Arthur Liesz; Roland Veltkamp Journal: Stroke Date: 2009-08-06 Impact factor: 7.914
Authors: Harold P Adams; Gregory del Zoppo; Mark J Alberts; Deepak L Bhatt; Lawrence Brass; Anthony Furlan; Robert L Grubb; Randall T Higashida; Edward C Jauch; Chelsea Kidwell; Patrick D Lyden; Lewis B Morgenstern; Adnan I Qureshi; Robert H Rosenwasser; Phillip A Scott; Eelco F M Wijdicks Journal: Stroke Date: 2007-04-12 Impact factor: 7.914
Authors: Ladina Joos; Prashant N Chhajed; Julia Wallner; Manuel Battegay; Juerg Steiger; Alois Gratwohl; Michael Tamm Journal: Respir Med Date: 2006-06-05 Impact factor: 3.415
Authors: Sean J Pittock; Dara Meldrum; Orla Hardiman; John Thornton; Paul Brennan; Joan T Moroney Journal: J Stroke Cerebrovasc Dis Date: 2003-01 Impact factor: 2.136
Authors: Lena Ulm; Sarah Hoffmann; Darius Nabavi; Marcella Hermans; Bruno-Marcel Mackert; Frank Hamilton; Ingo Schmehl; Gerhard-Jan Jungehuelsing; Joan Montaner; Alejandro Bustamante; Mira Katan; Andreas Hartmann; Stefan Ebmeyer; Christiane Dinter; Jan C Wiemer; Sabine Hertel; Christian Meisel; Stefan D Anker; Andreas Meisel Journal: Front Neurol Date: 2017-04-24 Impact factor: 4.003
Authors: Arthur Liesz; Holger Rüger; Jan Purrucker; Markus Zorn; Alexander Dalpke; Markus Möhlenbruch; Stefan Englert; Peter P Nawroth; Roland Veltkamp Journal: PLoS One Date: 2013-09-19 Impact factor: 3.240
Authors: Benjamin Hotter; Sarah Hoffmann; Lena Ulm; Joan Montaner; Alejandro Bustamante; Christian Meisel; Andreas Meisel Journal: Neurol Neuroimmunol Neuroinflamm Date: 2020-02-25