Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Department Of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
Pan Afr Med J. 2024 Feb 5;47:43. doi: 10.11604/pamj.2024.47.43.37617. eCollection 2024.
central fever is defined as elevated body temperature without any evidence of infection or drug reaction fever, and currently it has no definitive diagnostic criteria. The current study aims to assess the role of procalcitonin (PCT) in differentiating central fever from fever secondary to infections in patients with neurological insults.
we conducted a retrospective study of patients admitted with a neurological insult (brain trauma, brain tumors and cerebrovascular accidents) in a tertiary care hospital. All patients who developed fever 48 hours after admission and had procalcitonin, C-reactive protein (CRP), and Erythrocyte sedimentation rate (ESR) done as part of fever evaluation were assessed to include in the study.
out of 70 patients who met inclusion criteria, 37 had infections identified and 33 had no source of infection. The mean age was 42.9 years (± 18) in the infectious group while 40.3 years (± 18.2) in the central fever group and there was male predominance in both groups. In the infectious group there were 25(67.6%) males vs. 12(32.4%) females while in non -infectious group, males vs. females were 18(54.5%) vs. 15(45.5%) and there was no difference in both group (p-value 0.26) Median procalcitonin (PCT) value was 0.09 ng/dl (IQR 0.05- 0.19) in patients with no identified cause of infection and 1.4 ng/dl (IQR 0.5-5.1) in patients with infections with a p-value of <0.001. Although CRP and ESR were low in patients with central fever as compared to those with infections, these differences did not reach statistical significance with p-value of CRP 0.18 and p-value of ESR 0.31 between two groups.
PCT levels were low in patients with central fever and may be considered as a useful biomarker to differentiate between infectious fever from non-infectious fever in patients with brain injury. This can prevent unnecessary antibiotic use in patients without infection.
中枢性发热是指在没有任何感染或药物反应发热证据的情况下体温升高，目前尚无明确的诊断标准。本研究旨在评估降钙素原（PCT）在区分神经损伤患者的中枢性发热与感染引起的发热中的作用。
我们对一家三级保健医院收治的有神经损伤（脑外伤、脑肿瘤和脑血管意外）的患者进行了回顾性研究。所有在入院后 48 小时出现发热且已进行降钙素原、C 反应蛋白（CRP）和红细胞沉降率（ESR）检查以评估发热原因的患者均被评估纳入研究。
在符合纳入标准的 70 名患者中，有 37 名患者确定存在感染，33 名患者无感染源。感染组的平均年龄为 42.9 岁（±18），而中枢性发热组的平均年龄为 40.3 岁（±18.2），两组均以男性为主。在感染组中，有 25 名（67.6%）男性患者，12 名（32.4%）女性患者；而在非感染组中，有 18 名（54.5%）男性患者，15 名（45.5%）女性患者，两组间无差异（p 值为 0.26）。无明确感染原因的患者的降钙素原（PCT）中位数为 0.09ng/dl（IQR 0.05-0.19），而有感染的患者的 PCT 中位数为 1.4ng/dl（IQR 0.5-5.1），p 值<0.001。与感染患者相比，中枢性发热患者的 CRP 和 ESR 较低，但两组间差异无统计学意义（CRP 的 p 值为 0.18，ESR 的 p 值为 0.31）。
中枢性发热患者的 PCT 水平较低，可作为区分脑损伤患者感染性发热与非感染性发热的有用生物标志物，从而避免对无感染患者使用不必要的抗生素。
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