Multiple inflammatory mechanisms are activated by aneurysmal subarachnoid haemorrhage (aSAH), which might contribute to delayed cerebral ischemia (DCI). The temporal course of procalcitonin (PCT), a well-established marker for sepsis therapy monitoring, is unknown in the context of DCI after aSAH. The purpose of this study was to see if there was a correlation between the predictive and confirmative value of levels in the context of DCI. Between 2014 and 2018, all patients admitted to the authors’ institution with aSAH were prospectively screened for eligibility. PCT levels were monitored on a daily basis, along with important aSAH features. A receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the predictive and confirmative values of PCT levels. The PCT levels around the DCI event ebbed and flowed.

There were 132 patients with aSAH in all. Early PCT levels (first 3 days post-aSAH) exhibited a low predictive value for DCI (AUC 0.661, SE 0.050; p = 0.003) and a negative long-term outcome (i.e., Glasgow Outcome Scale–Extended scores 1–4; AUC 0.674, SE 0.054; p = 0.003). PCT levels were greater in paediatric patients (n = 72) in a subgroup study of infection-free individuals.Higher PCT levels in the early stages were linked to the later development of DCI and an adverse outcome. Nosocomial infections make it difficult to analyse PCT after the first several days following a bleed. PCT levels rise during DCI in infection-free patients, and they rise even more in patients who have cerebral infarction.

Reference Link – https://thejns.org/view/journals/j-neurosurg/135/1/article-p29.xml