Department of Neurology, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany.
Neurocrit Care. 2011 Jun;14(3):416-22. doi: 10.1007/s12028-009-9325-6.
Patients with extensive brain infarcts are at increased risk for stroke-associated respiratory tract infections (SARTI), which cause worse outcome. The benefit of general antibiotic prophylaxis is controversial. Early diagnosis of SARTI may improve patient selection for antimicrobial therapy. Procalcitonin (PCT) is widely recognized as serum marker for bacterial infections. Its diagnostic value with respect to SARTI has not been assessed systematically.
Serum PCT levels were analyzed in ischemic stroke patients (n = 50) at day 1 (d1) and day 4 (d4) after stroke onset. PCT test performance was assessed by receiver operator characteristics (ROC) curve analysis. Multivariable logistic regression analysis was applied to identify early predictors for SARTI.
Higher d4 serum PCT levels were associated with SARTI; ROC curve analysis revealed an area under the curve (AUC) of 0.79 (95%-confidence interval (CI) 0.61-0.96). A 0.25-ng/ml cutoff resulted in a test sensitivity and specificity of 42 and 96%, respectively. Positive (LR+) and negative (LR-) likelihood ratios were 10.8 and 0.6, respectively. In predicting SARTI, multivariable logistic regression analysis controlling for infarct volume ruled out an independent explanatory effect of serum PCT. Greater infarct volume (odds ratio (OR) 1.06, 95%-CI 1.02-1.1) prevailed as independent SARTI-predictor.
In the absence of clinical signs, post-stroke screening for SARTI using serum PCT levels is not useful since test sensitivity is low. If the clinical suspicion for SARTI is strong, serum PCT-testing (>0.25 ng/ml) may improve diagnostic accuracy by improving specificity.
大面积脑梗死患者发生卒中相关性呼吸道感染（SARTI）的风险增加，这会导致更差的预后。全身性抗生素预防的益处存在争议。早期诊断 SARTI 可能会改善抗菌治疗的患者选择。降钙素原（PCT）被广泛认为是细菌感染的血清标志物。其在 SARTI 中的诊断价值尚未系统评估。
在卒中发病后第 1 天（d1）和第 4 天（d4）分析缺血性卒中患者（n=50）的血清 PCT 水平。通过接受者操作特征（ROC）曲线分析评估 PCT 检测性能。应用多变量逻辑回归分析来确定 SARTI 的早期预测因子。
较高的 d4 血清 PCT 水平与 SARTI 相关；ROC 曲线分析显示曲线下面积（AUC）为 0.79（95%置信区间（CI）0.61-0.96）。0.25ng/ml 的截断值可使检测的灵敏度和特异性分别为 42%和 96%。阳性（LR+）和阴性（LR-）似然比分别为 10.8 和 0.6。在预测 SARTI 时，多变量逻辑回归分析排除了血清 PCT 的独立解释作用，而控制梗死体积后。较大的梗死体积（比值比（OR）1.06，95%CI 1.02-1.1）作为独立的 SARTI 预测因子占主导地位。
在没有临床体征的情况下，使用血清 PCT 水平对 SARTI 进行卒中后筛查没有用，因为检测的灵敏度低。如果对 SARTI 的临床怀疑强烈，血清 PCT 检测（>0.25ng/ml）可能通过提高特异性来提高诊断准确性。
