Impact of body temperature and serum procalcitonin on the outcomes of critically ill neurological patients

Introduction

Fever is common in patients with acute stroke, and mostly it is due to infectious complications. The neurologic effects of fever are significant, increased temperature in the post-injury period has been associated with increased cytokine activity and increased infarct size.

Aim

To test the hypothesis that fever and increased serum procalcitonin are associated with poor outcomes after neurological injury.

Methodology

Fifty patients (30 males (60%) and 20 females (40%) mean 43.8 ± 11.7 years) were divided into two groups: Group I: 25 traumatic patients (i.e., head injury) and Group II: 25 non-traumatic patients (i.e., stroke). Temperature was measured from admission until the patients were discharged or died, and PCT was measured on day 1 of admission and after 48 h of admission.

Results

Fever has been associated with poor outcome, as fever is linked to worse GCS scores (12.6 ± 1.2 vs. 7.7 ± 2.6 in patients with fever, P 0.001), longer MV durations (3.6 ± 1.0 vs. 22.4 ± 9.1 days, in patients with fever, P 0.001), longer ICU length of stay (8.1 ± 4.7 vs. 23.0 ± 8.0 days in patients with fever, P 0.001) and increased mortality (P = 0.001). There were significantly higher PCT levels in the mortality group versus the survived group at day 1 (4.15 ± 0.82 vs. 2.47 ± 0.059 ng/ml, respectively, P 0.0001) and after 48 h of admission (5.20 ± 1.14 vs. 3.19 ± 0.092 ng/ml, respectively, P 0.0001).

Conclusion

Fever had a strong link to worse GCS, longer MV durations, increased length of ICU stay, higher mortality rates and worse overall outcomes in neurocritical patients. High PCT levels can predict mortality in those patients.