gms | German Medical Science

Objective: Procalcitonin (PCT) is a systemic sepsis marker. Increased PCT levels could be identified as a prognostic factor for unfavorable neurological outcome in intensive care patients. However, the role of serum PCT levels in patients with aneurysmal subarachnoid hemorrhage (SAH) is unclear. We therefore analyzed patients with SAH concering early PCT levels and neurological outcome.

Methods: Early PCT levels (within 48 hours after admission, “PCT 48h”) were assessed in 216 patients between 2014 and May 2018. Further PCT values were collected during the first week at day 4 (PCT d4), and day 6 (PCT d6). Patients were divided into two groups according to the PCT level: low PCT level (<0.5µg/l) versus high PCT level (≥0.5µg/l). The PCT 4d group was subdivided into patients with initially low PCT and secondary increase on the 4th day. Neurological outcome was assessed and further analyzed according to the modified Rankin Scale (mRS) after 6 months.

Results: Increased early PCT levels (PCT 48h) were present in 11 patients. All of the 11 patients died within the next 6 months.

Outcome of SAH patients differed according to the groups at an early stage low versus high PCT level at PCT 48h (mRS mean 3±2,3 vs. 6±0; p<0,001), and in the PCT 4d group (mean mRS 3±2,3 vs. 5±1,8; p=0.0009). There was no difference in patients in the PCT d6 group according to the PCT-levels (p=0.2).

Furthermore, outcome differed significantly in the group of patients with low PCT values within 48h but elevated PCT values within 4d versus low PCT values within 4d (mean mRS 5±2 vs. 3±2,2; p=0.006).

Conclusion: The present data suggests that an early elevated PCT level in patients with SAH is associated with an unfavorable neurological outcome, and might reflect the systemic stress response.