Comparison of procalcitonin, C-reactive protein, white blood cell and body temperature in the diagnosis of ventriculostomy-associated infection

Yıl 2019, Cilt: 44 Sayı: Ek 1, 69 - 76, 29.12.2019

Ali Arslan Semih Kıvanç Olguner Vedat Açık Faruk İldan Ali İhsan Ökten

https://doi.org/10.17826/cumj.551752

Öz

Purpose: The aim of this study was to evaluate the effect of neurosurgical procedures on procalcitonin levels and the role of procalcitonin in distinguishing the inflammatory reaction due to surgery and postoperative infection.

Materials and Methods: This study was performed on 27 patients with hydrocephalus. Among these patients, 10 patients had ventricular drainage while 17 had ventriculoperitoneal shunt. The changes in the values of procalcitonin, white blood cell count, C-reactive protein and body temperature were examined in the preoperative 1st and during postoperative 7 days. 

Results:  All the patients had statistically significant increase in the body temperature values of the postoperative 1st day compared to preoperative values. C-reactive protein peaked in the postoperative 2nd day and, after that, followed a regular kinetic to show a decrease pattern. C-reactive protein was found to be 3 times higher in the postoperative 5th day compared to the preoperative value. Procalcitonin was found to remain in normal limits in all the patients that did not develop infection while the same was observed to increase in patients with infection.

Conclusion: Procalcitonin will be a serious and safer parameter for the follow-up of the systemic complications following surgery upon the conclusions obtained with studies that include a higher number of patients and varying types of operations.

Anahtar Kelimeler

Procalcitonin, Ventriculostomy-Associated Infection

Ventrikülostomi sonrası gelişen enfeksiyon tanısında prokalsitoninin C-reaktif protein, beyaz küre ve ateşle karşılaştırılması

Öz

Amaç:  Bu çalışmada beyin cerrahisinin prokalsitonin düzeylerine etkisini ve prokalsitoninin beyin cerrahisinin yaratmış olduğu enflamatuar reaksiyonla, postoperatif gelişen enfeksiyonu ayırt etme özelliği araştırılmıştır.

Gereç ve Yöntem: Çalışmamız 10’unda ventriküler drenaj, 17’sinde ventriküloperitoneal şant uygulanan 27 hidrosefalili hastada yapılmıştır. Preoperatif 1 ve postoperatif 7 gün boyunca Prokalsitonin, Beyaz küre sayısı, C-reaktif protein ve ateş değerlerindeki değişimler incelenmiştir.

Bulgular: Tüm hastalarda postoperatif 1. günde preoperatif değerlere göre ateş değerlerinde anlamlı yükseklik tespit edilmiştir. C-reaktif proteinin postoperatif 2. günde pik yaptığı ve daha sonra azalma paterni gösteren düzenli bir kinetik izlediği gözlenmiştir. Postoperatif 5. günde, C-reaktif proteinin halen preoperatif değerinin 3 katı kadar yüksek olduğu tespit edilmiştir. Prokalsitoninin  enfeksiyon  gelişmeyen  tüm  hastalarda postoperatif normal sınırları aşmadığı, enfeksiyon gelişen hastalarda ise arttığı gözlenmiştir.

Sonuç: Gelecekte daha fazla hasta sayısı ve farklı operasyon türlerini de içeren gruplarla yapılacak çalışmaların sonuçlarıyla prokalsitoninin beyin cerrahi sonrası sistemik komplikasyonları takipte ciddi ve güvenli bir parametre olacağını düşünmekteyiz.

Anahtar Kelimeler

Prokalsitonin, Ventrikülostomi İlişkili Enfeksiyon

Kaynakça

• 1. Balk RA. Systemic inflammatory response syndrome (SIRS). Virulence [Internet]. 2014 Jan 13 [cited 2019 Jan 18];5(1):20–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24280933
• 2. Miglietta F, Faneschi ML, Lobreglio G, Palumbo C, Rizzo A, Cucurachi M, et al. Procalcitonin, C-reactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis, SIRS and systemic candidiasis. Infez Med [Internet]. 2015 Sep [cited 2019 Jan 18];23(3):230–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26397291
• 3. Kip MMA, Kusters R, IJzerman MJ, Steuten LMG. A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis. J Med Econ [Internet]. 2015 Nov 2 [cited 2019 Jan 18];18(11):944–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26105574
• 4. Pontrelli G, De Crescenzo F, Buzzetti R, Jenkner A, Balduzzi S, Calò Carducci F, et al. Accuracy of serum procalcitonin for the diagnosis of sepsis in neonates and children with systemic inflammatory syndrome: a meta-analysis. BMC Infect Dis [Internet]. 2017 Dec 24 [cited 2019 Jan 18];17(1):302. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28438138
• 5. Ammirati M, Raimondi AJ. Cerebrospinal fluid shunt infections in children. A study on the relationship between the etiology of hydrocephalus, age at the time of shunt placement, and infection rate. Childs Nerv Syst [Internet]. 1987 [cited 2018 Jun 21];3(2):106–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3621226
• 6. Caldarelli M, Di Rocco C, La Marca F. Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst [Internet]. 1996 Dec [cited 2018 Jun 21];12(12):748–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9118142
• 7. Kanangi SMR, Balasubramaniam C. Shunt infections: a review and analysis of a personal series. Child’s Nerv Syst [Internet]. 2018 Oct 5 [cited 2019 Jan 17];34(10):1915–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29978253
• 8. Gathura E, Poenaru D, Bransford R, Albright AL. Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa. J Neurosurg Pediatr [Internet]. 2010 Oct [cited 2019 Jan 17];6(4):329–35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20887104
• 9. Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg [Internet]. 1984 May [cited 2018 Jun 21];60(5):1014–21. Available from: http://thejns.org/doi/10.3171/jns.1984.60.5.1014
• 10. Bengzon J, Grubb A, Bune A, Hellström K, Lindström V, Brandt L. C-reactive protein levels following standard neurosurgical procedures. Acta Neurochir (Wien) [Internet]. 2003 Jan 1 [cited 2019 Jan 17];145(8):667–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14520546
• 11. Santonocito C, De Loecker I, Donadello K, Moussa MD, Markowicz S, Gullo A, et al. C-Reactive Protein Kinetics After Major Surgery. Anesth Analg [Internet]. 2014 Sep [cited 2019 Jan 17];119(3):624–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24878684
• 12. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J [Internet]. 1997 Aug [cited 2019 Jan 17];16(8):735-46; quiz 746-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9271034
• 13. Omar AS, ElShawarby A, Singh R. Early monitoring of ventriculostomy-related infections with procalcitonin in patients with ventricular drains. J Clin Monit Comput [Internet]. 2015 Dec 1 [cited 2019 Jan 18];29(6):759–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25638513
• 14. Wei T-T, Hu Z-D, Qin B-D, Ma N, Tang Q-Q, Wang L-L, et al. Diagnostic Accuracy of Procalcitonin in Bacterial Meningitis Versus Nonbacterial Meningitis. Medicine (Baltimore) [Internet]. 2016 Mar [cited 2019 Jan 18];95(11):e3079. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26986140
• 15. Park BS, Kim SE, Park SH, Kim J, Shin KJ, Ha SY, et al. Procalcitonin as a potential predicting factor for prognosis in bacterial meningitis. J Clin Neurosci [Internet]. 2017 Feb [cited 2019 Jan 18];36:129–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28341167
• 16. Mandell IM, Aghamohammadi S, Deakers T, Khemani RG. Procalcitonin to Detect Suspected Bacterial Infections in the PICU. Pediatr Crit Care Med [Internet]. 2016 Jan [cited 2019 Jan 18];17(1):e4–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26492060
• 17. Memar MY, Varshochi M, Shokouhi B, Asgharzadeh M, Kafil HS. Procalcitonin: The marker of pediatric bacterial infection. Biomed Pharmacother [Internet]. 2017 Dec [cited 2019 Jan 18];96:936–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29203386
• 18. Shimetani N, Shimetani K, Mori M. Levels of three inflammation markers, C-reactive protein, serum amyloid A protein and procalcitonin, in the serum and cerebrospinal fluid of patients with meningitis. Scand J Clin Lab Invest [Internet]. 2001 [cited 2019 Jan 18];61(7):567–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11763415
• 19. Henry BM, Roy J, Ramakrishnan PK, Vikse J, Tomaszewski KA, Walocha JA. Procalcitonin as a Serum Biomarker for Differentiation of Bacterial Meningitis From Viral Meningitis in Children. Clin Pediatr (Phila) [Internet]. 2016 Jul 15 [cited 2019 Jan 18];55(8):749–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26378091
• 20. Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schüttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med [Internet]. 1998 Jul [cited 2019 Jan 18];24(7):680–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9722037
• 21. Yu Y, Li HJ. Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy. Brazilian J Med Biol Res = Rev Bras Pesqui medicas e Biol [Internet]. 2017 Apr 20 [cited 2019 Jan 18];50(5):e6021. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28443989
• 22. Scherer MA, Neumaier M, von Gumppenberg S. C-reactive protein in patients who had operative fracture treatment. Clin Orthop Relat Res [Internet]. 2001 Dec [cited 2019 Jan 18];(393):287–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11764361
• 23. Woernle CM, Neidert MC, Wulf M-A, Burkhardt J-K, Grunwald T, Bernays R-L. Excessively elevated C-reactive protein after surgery for temporal lobe epilepsy. Clin Neurol Neurosurg [Internet]. 2013 Aug [cited 2019 Jan 18];115(8):1245–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23266263