title: Copeptin, procalcitonin and routine inflammatory markers-predictors of infection after stroke.
abstract: BACKGROUND
  Early predictors for the development of stroke-associated infection may identify patients at high risk and reduce post-stroke infection and mortality.
  
  
  METHODS
  In 383 prospectively enrolled acute stroke patients we assessed time point and type of post-stroke infections (i.e. pneumonia, urinary tract infection (UTI) other infection (OI)). Blood samples were collected on admission, and days 1, and 3 to assess white blood cells (WBC), monocytes, C-reactive protein (CRP), procalcitonin (PCT), and copeptin. To determine the magnitude of association with the development of infections, odds ratios (OR) were calculated for each prognostic blood marker. The discriminatory ability of different predictors was assessed, by calculating area under the receiver operating characteristic curves (AUC). Prognostic models including the three parameters with the best performance were identified.
  
  
  RESULTS
  Of 383 patients, 66 (17.2%) developed an infection after onset of stroke. WBC, CRP, copeptin and PCT were all independent predictors of any infection, pneumonia and UTI developed at least 24 hours after measurements. The combination of the biomarkers WBC, CRP and copeptin (AUC: 0.92) and WBC, CRP and PCT (AUC: 0.90) showed a better predictive accuracy concerning the development of pneumonia during hospitalization compared to each marker by itself (p-Wald <0.0001).
  
  
  CONCLUSIONS
  Among ischemic stroke patients, copeptin, PCT, WBC and CRP measured on admission were predictors of infection in general, and specifically for pneumonia and UTI within 5 days after stroke. The combination of these biomarkers improved the prediction of patients who developed an infection.
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland. ffluri@gmx.ch
authors.forename: Felix
authors.initials: F
authors.lastname: Fluri
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.forename: Mira
authors.initials: M
authors.lastname: Katan
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000150:complications; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D007239:Infections / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D007249:Inflammation / Q000097:blood; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D020521:Stroke / Q000150:complications*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006020:Glycopeptides; D011498:Protein Precursors; C048197:copeptins; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide