title: Acute phase proteins and white blood cell levels for prediction of infectious complications in status epilepticus.
abstract: BACKGROUND
  Infections in status epilepticus (SE) patients result in severe morbidity making early diagnosis crucial. As SE may lead to inflammatory reaction, the value of acute phase proteins and white blood cells (WBC) for diagnosis of infections during SE may be important. We examined the reliability of C-reactive protein (CRP), procalcitonin (PCT), and WBC for diagnosis of infections during SE.
  
  
  METHODS
  All consecutive SE patients treated in the ICU from 2005 to 2009 were included. Clinical and microbiological records, and measurements of CRP and WBC during SE were analyzed. Subgroup analysis was performed for additional PCT measurements in the first 48 hours of SE.
  
  
  RESULTS
  A total of 22.5% of 160 consecutive SE patients had infections during SE. Single levels of CRP and WBC had no association with the presence of infections. Their linear changes over the first three days after SE onset were significantly associated with the presence of infections (P = 0.0012 for CRP, P = 0.0137 for WBC). Levels of PCT were available for 31 patients and did not differ significantly in patients with and without infections. Sensitivity of PCT and CRP was high (94% and 83%) and the negative predictive value of CRP increased over the first three days to 97%. Specificity was low, without improvement for different cut-offs.
  
  
  CONCLUSIONS
  Single levels of CRP and WBC are not reliable for diagnosis of infections during SE, while their linear changes over time significantly correlate with the presence of infections. In addition, low levels of CRP and PCT rule out hospital-acquired infections in SE patients.
authors.affiliation: Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Peterplatz 1, Basel, 4003, Switzerland. SutterR@uhbs.ch
authors.forename: Raoul
authors.initials: R
authors.lastname: Sutter
authors.forename: Sarah
authors.initials: S
authors.lastname: Tschudin-Sutter
authors.forename: Leticia
authors.initials: L
authors.lastname: Grize
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.forename: Stephan
authors.initials: S
authors.lastname: Rüegg
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000032:analysis; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis* / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000032:analysis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013226:Status Epilepticus / Q000097:blood / Q000150:complications* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
references.citation: Eur J Clin Invest. 2010 Apr;40(4):376-81
references.pmid: 20192974
references.citation: J Emerg Med. 1999 Nov-Dec;17(6):1019-25
references.pmid: 10595891
references.citation: Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416
references.pmid: 15699079
references.citation: Minerva Anestesiol. 2006 Jan-Feb;72(1-2):69-80
references.pmid: 16407808
references.citation: Am J Infect Control. 1988 Jun;16(3):128-40
references.pmid: 2841893
references.citation: Epilepsia. 1995 Apr;36(4):384-7
references.pmid: 7607117
references.citation: Biochem Biophys Res Commun. 1988 Aug 30;155(1):112-7
references.pmid: 3261980
references.citation: Crit Care Med. 2008 Mar;36(3):941-52
references.pmid: 18431284
references.citation: Int J Antimicrob Agents. 2007 Nov;30 Suppl 1:S16-23
references.pmid: 17884358
references.citation: JAMA. 1993 Aug 18;270(7):854-9
references.pmid: 8340986
references.citation: Lancet. 2010 Feb 6;375(9713):463-74
references.pmid: 20097417
references.citation: Epilepsia. 2005 Nov;46(11):1724-43
references.pmid: 16302852
references.citation: BMC Infect Dis. 2009 Apr 22;9:49
references.pmid: 19386110
references.citation: J Neurotrauma. 2003 Oct;20(10):953-60
references.pmid: 14588112
references.citation: Epilepsy Res. 2008 Dec;82(2-3):171-6
references.pmid: 18783922
references.citation: Respir Care. 2011 Apr;56(4):412-9
references.pmid: 21255510
references.citation: Seizure. 2011 Apr;20(3):249-56
references.pmid: 21216630
references.citation: Am J Med. 2004 Apr 15;116(8):529-35
references.pmid: 15063814
references.citation: Epilepsy Behav. 2008 Apr;12(3):477-80
references.pmid: 18291724
references.citation: Nat Rev Neurol. 2011 Jan;7(1):31-40
references.pmid: 21135885
references.citation: N Engl J Med. 1998 Sep 17;339(12):792-8
references.pmid: 9738086
references.citation: Neurology. 1996 Jul;47(1):83-9
references.pmid: 8710130
references.citation: Eur Respir J. 2008 Feb;31(2):356-62
references.pmid: 17959634
references.citation: Surgery. 1990 Dec;108(6):1097-101
references.pmid: 2247835
references.citation: BMC Infect Dis. 2009 Dec 22;9:213
references.pmid: 20028533
references.citation: Anaesth Intensive Care. 2006 Oct;34(5):639-44
references.pmid: 17061641
references.citation: Pathology. 1991 Apr;23(2):118-24
references.pmid: 1720888
references.citation: J Microbiol Immunol Infect. 1999 Jun;32(2):73-82
references.pmid: 11561579
references.citation: Seizure. 2002 Jan;11(1):44-6
references.pmid: 11888259
references.citation: JAMA. 2009 Sep 9;302(10):1059-66
references.pmid: 19738090
references.citation: Adv Intern Med. 1992;37:313-36
references.pmid: 1558000