The predictive value of C-reactive protein (CRP) and procalcitonin chemical biomarkers in the premature diagnosis of infection in brain ischemic stroke

Authors

  • Narges Najafi 1 Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2 Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran https://orcid.org/0000-0001-6603-6549
  • Alireza Davoudi 1 Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2 Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran https://orcid.org/0000-0002-1170-2206
  • Shahriar Alian 1 Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2 Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
  • Fatemeh Ahangarkani 3 Student Research Committee, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran 4 Universal Scientific Education and Research Network, Tehran, Iran
  • Mahmoud Abedini Department of Neurology, Mazandaran University of Medical Sciences, Sari, Iran
  • Roshina Hassantabar 1 Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2 Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
  • Reza Maleki-Gorji 1 Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2 Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
  • Salar Behzadnia Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran

DOI:

https://doi.org/10.22122/cdj.v7i3.464

Keywords:

C-Reactive Protein, Procalcitonin, Infection, Ischemia

Abstract

BACKGROUND: The infections are common complications after the ischemic stroke. The aim of this study was to evaluate the anticipatory value of C-reactive protein (CRP) and procalcitonin (PCT) biomarkers in diagnosis of stroke-induced infection.

METHODS: In the current prospective study, 184 patients with cerebral ischemia were enrolled. Serum samples were obtained from patients. The CRP and PCT, white blood cells (WBCs) and monocytes, and final infections were evaluated.

RESULTS: In the first 72 hours, the analysis for CRP revealed that the sensitivity was 41.60%, the specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 82.90%. PCT showed that the sensitivity was 85.41%, the specificity was 98.54%, PPV was 95.34%, and NPV was 95%.

CONCLUSION: According to our findings, the evaluation of CRP and PCT with simultaneous clinical observation could be considered as a good step in start of antibiotic therapy.

References

Chamorro A, Horcajada JP, Obach V, Vargas M, Revilla M, Torres F, et al. The early systemic prophylaxis of infection after stroke study: A randomized clinical trial. Stroke 2005; 36(7): 1495-500.

Vargas M, Horcajada JP, Obach V, Revilla M, Cervera A, Torres F, et al. Clinical consequences of infection in patients with acute stroke: Is it prime time for further antibiotic trials? Stroke 2006; 37(2): 461-5.

Weimar C, Roth MP, Zillessen G, Glahn J, Wimmer ML, Busse O, et al. Complications following acute ischemic stroke. Eur Neurol 2002; 48(3): 133-40.

Chamorro A, Urra X, Planas AM. Infection after acute ischemic stroke: A manifestation of brain-induced immunodepression. Stroke 2007; 38(3): 1097-103.

Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve-an integrative interface between two supersystems: The brain and the immune system. Pharmacol Rev 2000; 52(4): 595-638.

Harms H, Reimnitz P, Bohner G, Werich T, Klingebiel R, Meisel C, et al. Influence of stroke localization on autonomic activation, immunodepression, and post-stroke infection. Cerebrovasc Dis 2011; 32(6): 552-60.

Aslanyan S, Weir CJ, Diener HC, Kaste M, Lees KR. Pneumonia and urinary tract infection after acute ischaemic stroke: A tertiary analysis of the GAIN International trial. Eur J Neurol 2004; 11(1): 49-53.

Vermeij FH, Scholte op Reimer WJ, de Man P, van Oostenbrugge RJ, Franke CL, de Jong G, et al. Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: Data from the Netherlands Stroke Survey. Cerebrovasc Dis 2009; 27(5): 465-71.

Salat D, Delgado P, Alonso S, Ribo M, Santamarina E, Quintana M, et al. Ischemic stroke outcome and early infection: Its deleterious effect seems to operate also among tissue plasminogen activator-treated patients. Eur Neurol 2011; 65(2): 82-7.

Emsley HC, Smith CJ, Tyrrell PJ, Hopkins SJ. Inflammation in acute ischemic stroke and its relevance to stroke critical care. Neurocrit Care 2008; 9(1): 125-38.

Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. The role of procalcitonin in febrile neutropenic patients: Review of the literature. Infection 2008; 36(5): 396-407.

Kofoed K, Andersen O, Kronborg G, Tvede M, Petersen J, Eugen-Olsen J, et al. Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: A prospective study. Crit Care 2007; 11(2): R38.

Wartenberg KE, Stoll A, Funk A, Meyer A, Schmidt JM, Berrouschot J. Infection after acute ischemic stroke: Risk factors, biomarkers, and outcome. Stroke Res Treat 2011; 2011: 830614.

Vogelgesang A, Grunwald U, Langner S, Jack R, Broker BM, Kessler C, et al. Analysis of lymphocyte subsets in patients with stroke and their influence on infection after stroke. Stroke 2008; 39(1): 237-41.

Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull 2009; 92: 7-32.

Meisel C, Schwab JM, Prass K, Meisel A, Dirnagl U. Central nervous system injury-induced immune deficiency syndrome. Nat Rev Neurosci 2005; 6(10): 775-86.

Koennecke HC, Belz W, Berfelde D, Endres M, Fitzek S, Hamilton F, et al. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology 2011; 77(10): 965-72.

Tian D, Zhang S, He X, Liu H. Serum procalcitonin as a diagnostic marker in acute ischemic stroke. Neuroreport 2015; 26(1): 33-7.

Fluri F, Morgenthaler NG, Mueller B, Christ-Crain M, Katan M. Copeptin, procalcitonin and routine inflammatory markers-predictors of infection after stroke. PLoS One 2012; 7(10): e48309.

Worthmann H, Tryc AB, Dirks M, Schuppner R, Brand K, Klawonn F, et al. Lipopolysaccharide binding protein, interleukin-10, interleukin-6 and C-reactive protein blood levels in acute ischemic stroke patients with post-stroke infection. J Neuroinflammation 2015; 12: 13.

Welsh P, Barber M, Langhorne P, Rumley A, Lowe GD, Stott DJ. Associations of inflammatory and haemostatic biomarkers with poor outcome in acute ischaemic stroke. Cerebrovasc Dis 2009; 27(3): 247-53.

Deng WJ, Shen RL, Li M, Teng JF. Relationship between procalcitonin serum levels and functional outcome in stroke patients. Cell Mol Neurobiol 2015; 35(3): 355-61.

Wang C, Gao L, Zhang ZG, Li YQ, Yang YL, Chang T, et al. Procalcitonin is a stronger predictor of long-term functional outcome and mortality than high-sensitivity C-reactive protein in patients with ischemic stroke. Mol Neurobiol 2016; 53(3): 1509-17.

Xie J, Zhang XH, Zhu WY. Values for serum procalcitonin, C-reactive protein, and soluble triggering receptor expressed on myeloid cells-1 in predicting survival of patients with early-onset stroke-associated pneumonia. Genet Mol Res 2015; 14(2): 4716-23.

Downloads

Published

2019-08-22

How to Cite

1.
Najafi N, Davoudi A, Alian S, Ahangarkani F, Abedini M, Hassantabar R, Maleki-Gorji R, Behzadnia S. The predictive value of C-reactive protein (CRP) and procalcitonin chemical biomarkers in the premature diagnosis of infection in brain ischemic stroke. Chron Dis J. 2019;7(3):175–180.

Issue

Section

Original Article(s)