Is procalcitonin a marker of critical illness in heatstroke?
OBJECTIVE
To study the effect of non-exertional heatstroke on serum procalcitonin (PCT) levels.


METHODS
Cohort study.


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


METHODS
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.


METHODS
None.


METHODS
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.


CONCLUSIONS
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.
Hausfater
Pierre
P
Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, Cedex 13, France. pierre.hausfater@psl.aphp.fr
Hurtado
Margarita
M
Pease
Sebastian
S
Juillien
Gaëlle
G
Lvovschi
Virginie-Eve
VE
Salehabadi
Sepehr
S
Lidove
Olivier
O
Wolff
Michel
M
Bernard
Maguy
M
Chollet-Martin
Sylvie
S
Riou
Bruno
B
D000368:Aged; D015415:Biomarkers; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D055874:Extreme Heat / Q000009:adverse effects*; D005260:Female; D018883:Heat Stroke / Q000097:blood* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010297:Paris; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide