| Research BackgroundSpontaneous intracranial hemorrhage(sICH)is one of the common subtype of fatal stroke,and its mortality and disability rates are high.With the more and more sever aging problem and the increasing number of hypertension patients world widely,the incidence of sICH showed an increasing trend.Whether there is a concurrent infection after stroke is significantly related to the prognosis.Repeated severe infections which can even cause multiple organ dysfunction syndrome(MODS)could be the main cause of death in patients with severe sICH.Early recognition and timely deal with complications of infection can improve the prognosis of patients.For the sICH patients with infection,the antibiotics should be used properly and in time;for the patients without infection,abuse of antibiotics should be strictly forbidden.therefore,it is crucial to explore whether patients with sICH are combined with infection or not.it is closely related with the patient’s condition evaluation,setting of treatment plan,the reasonable use of antibiotics,and the improvement the prognosis.Procalcitonin(PCT),a precursor of procalcitonin,as a newly discovered inflammatory marker,has been widely used in clinical practice to assist the diagnosis of infectious diseases.PCT is an important inflammatory marker for the evaluation of infection and has a unique advantage for the prediction of infection.It is also has undeniable value in the evaluation of disease severity,the evaluation of the treatment effect,the evaluation of disease prognosis and the guiding the application of antibiotics.Dynamic monitoring of serum PCT level may be helpful to evaluate the effect of early antimicrobial therapy and provide reference for timely adjustment of antibiotics usage.Objective:This study is aimed at exploring the relationship between serum PCT level and the prognostics of the sICH patients with infection via continuous monitoring of serum PCTMethods:A total of 130 sICH patients admitted to the emergency intensive care unit of the First Affiliated Hospital of Zhengzhou University from September 2015 to December 2018 were included in the study.According to whether there was infection during hospitalization,the patients were divided into infected group and non-infected group.According to whether they survived on the 28th day after admission,the patients were divided into survival group and death group.The serum PCT level at admission and on the 1st,2nd,3rd and 5th day after admission was compared between the two groups,and the predictive value of serum PCT level to the concurrent infection and prognosis was further studied.This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University,and informed consent is signed by all the participates.Patients’ general information collection:Hospitalization related laboratory results,gender,age,complications,white blood cell count,platelet count,hemoglobin,Glasgow coma score,and acute physiology and chronic health evaluation were collected.All the hospitalized patients were routinely examined for blood routine,urine routine,fecal routine,liver and kidney function and other indicators.Collection of infection indicators:Disposable temperature probe was used for continuous temperature detection after admission.When the temperature is higher than 37.2℃ or lower than 35.0℃,routine blood,urine,stool routine,pulmonary CT were performed when temperature is above 38.5 ℃ or below 35.0℃,the venous blood bacteria and fungi cultivation is needed.Urine cultivation is performed if the leukocytes count is abnormal in the urine routine.If stool properties change or fecal leukocytes count is abnormal,stool cultivation is strongly recommended.Sputum bacteria and fungi cultivation should be done for the patinets with symptoms like cough ets.Sinus CT examination can be performed for the patients without obvious and regular infection.Statistical analysis:SPSS 21.0 data package was used for statistical analysis.The taxa were expressed in terms of number of cases or percentage;Chi-square test was used for comparison;Continuous variables is displayed as mean ± standard deviation and analyzed by t test between groups;non-normal distribution of continuous variables which not meet the standard for normal distribution is described as M(P25,P75)and the Mann-Whitney U test is used for comparison;The receiver operating characteristic curve(ROC curve)was used to analyze the serum PCT level which contribute to the the clinical prognosis prediction of sICH patients on the 28th day.P<0.05 indicated that the difference was statistically significant.Results:1.General information and PCT level for study group and control group:A total of 130 sICH patients were included in this study,including 84 males and 46 females,with an average age of(54.98± 13.20)years old;The control group consists of 30 patients,including 18 males and 12 females,with an average age of(52.00± 12.21)years.There was no significant difference in age and gender between the study group and the control group(P>0.05).The median and upper and lower quartile of serum PCT levels at admission in the study group and the control group were 0.08(0.04,0.17)ng/ml and 0.05(0.04,0.09)ng/ml,respectively,with statistically significant differences(P<0.05).2.Comparison of general clinical data between the survival group and the death group:According to the survival situation on the 28th day of admission,130 patients were divided into the survival group(88 patients)and death group(42 patients).There were no statistically significant differences between the two groups in age,sex,smoking,alcohol abuse,hypertension,diabetes,hemoglobin concentration,platelet count,etc.(P>0.05).In the death group,CRP,WBC count,neutrophil count,concurrent infection and APACHEII score on admission were significantly higher than those in the survival group,while GCS score on admission was significantly lower than that in the survival group,and the differences were statistically significant(P<0.01).3.Comparison of serum PCT levels between the survival group and death group:the median and upper and lower quartile of serum PCT levels in the survival group and the death group at the time of admission were 0.066(0.039,0.151)and 0.119(0.053,0.250),respectively,with no statistically significant difference(P>0.05).The serum PCT levels of the survival group were 0.088(0.046,0.227),0.140(0.046,0.453),0.135(0.065,0.416),0.127(0.054,0.303),and 0.458(0.136,1.733)on the first,second,third,and fifth days after admission,respectively.The serum PCT levels of the death group were 0.458(0.136,1.733,1.100(0.308,9.258),0.938(0.394,5.725)and 0.839(0.206,4.690)ng/ml,on the first,second,third,and fifth days after admission,which is all significantly higher than the survival group(P<0.01).4.Comparison of serum PCT levels between the sICH combined with infection group and sICH group:The median and upper and lower quartile of serum PCT on the first,second,third,and fifth days after admission were 0.105(0.045,0.232),0.264(0.084,0.537),0.518(0.185,2.798),0.491(0.161,1.619),0.292(0.109,1.170)in the sICH combined with infection group.The median and upper and lower quartile of serum PCT on the first,second,third,and fifth days after admission were 0.061(0.036,0.132),0.064(0.031,0.131),0.100(0.040,0.263),0.110(0.050,0.354),0.088(0.050,0.250)in the sICH group,which is all significantly lower than the sICH combined with infection group(P<0.05).5.The predictive value of each indicator for the prognosis of the 28thday in sICH patients:The area under the curve for serum PCT,GCS score and APACHEII score on the 1st,2nd,3rd and 5th days,is 0.763(95%CI:0.660～0.865,P<0.01),0.793(95%CI:0.705～0.881,P<0.01),0.814(95%CI:0.729～0.900,P<0.01),0.783(95%CI:0.684～0.882,P<0.01),0.725(95%CI:0.629～0.821,P<0.01)and 0.771(95%CI:0.666～0.877,P<0.01),respectively.The area under the serum PCT level curve on the 3rd day was the largest,and the optimal truncation value of serum PCT on the 3rd day was 0.216ng/ml(sensitivity:87%,specificity:67%).6.Relationship between serum PCT level and survival rate on the 28th day of sICH patients:Patients were divided into high PCT group(PCT≥0.216ng/ml)and low PCT group(PCT<0.216ng/ml)according to the optimal PCT cutoff value(0.216ng/ml)on the 3rd day after admission.The survival rates on the 28th day of the high PCT group and the low PCT group were 32.1%and 86.2%,respectively,with statistically significant difference(x2=38.929,P<0.01).Conclusion:The PCT level on the 3rd day after admission has high sensitivity and specificity to predict the 28th day’s mortality rate of the sICH patients.The PCT monitoring of sICH patients should be strengthened,which has important clinical value in timely and appropriate initiation of anti-infective therapy,improving the survival rate and clinical prognosis of patients with cerebral hemorrhage. |
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