Is procalcitonin a marker of critical illness in heatstroke?

Abstract

OBJECTIVE:

To study the effect of non-exertional heatstroke on serum procalcitonin (PCT) levels.

DESIGN:

Cohort study.

SETTING:

The emergency and intensive care departments of two academic tertiary-care hospitals, Paris, France

PATIENTS:

A total of 53 patients with defined heatstroke attending the emergency department and/or the intensive care unit during the August 2003 heat wave in France.

INTERVENTIONS:

None.

MEASUREMENTS:

Serum PCT measurement using a sensitive assay and vital and routine biological variables on arrival of patients presenting with classic heatstroke. Thirty-day mortality was recorded.

RESULTS:

Among the 53 patients included, 14 (26%) were admitted to an intensive care unit (ICU). At 30 days, 24 patients (45%) had died. Median PCT value was 0.58 microg/l (95% confidence interval 0.16-1.61) and 31 (58%) patients had PCT above 0.2 microg/l (PCT+). Temperature above or equal to 40 degrees C was the only variable significantly associated with fatal outcome. Median PCT values were 1.4 microg/l (0.16-4.71) and 0.18 microg/l (0.12-1.61) in the group of deceased and surviving patients respectively (p = 0.22). All patients admitted in ICU had elevated PCT values. Patients PCT+ initially presented with a more pronounced systemic inflammatory response. Microbiologically or clinically documented infection was not more frequent in PCT+ group.

CONCLUSION:

High serum PCT levels can be observed in heatstroke without any concomitant documented bacterial infection. The PCT is not a valid mortality predictor in heatstroke but could be an indicator of the severity of illness. Heatstroke could represent a model of a "non-septic" pathway of PCT synthesis.

• Authors: Pierre Hausfater, Margarita Hurtado, Sebastian Pease, Gaëlle Juillien, Virginie-Eve Lvovschi, Sepehr Salehabadi, Olivier Lidove, Michel Wolff, Maguy Bernard, Sylvie Chollet-Martin, Bruno Riou
• Journal: Intensive care medicine (Intensive Care Med) Vol. 34 Issue 8 Pg. 1377-83 (Aug 2008) ISSN: 0342-4642 [Print] United States
• PMID: 18369592 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Biomarkers
• CALCA protein, human
• Protein Precursors
• Calcitonin
• Calcitonin Gene-Related Peptide

Topics

• Aged
• Biomarkers
• Calcitonin (blood)
• Calcitonin Gene-Related Peptide
• Cohort Studies
• Comorbidity
• Emergency Service, Hospital (statistics & numerical data)
• Extreme Heat (adverse effects)
• Female
• Heat Stroke (blood, mortality, physiopathology)
• Humans
• Intensive Care Units (statistics & numerical data)
• Male
• Middle Aged
• Paris
• Prognosis
• Protein Precursors (blood)