title: Procalcitonin after cardiac arrest - an indicator of severity of illness, ischemia-reperfusion injury and outcome.
abstract: OBJECTIVE
  To investigate serial serum concentrations of procalcitonin (PCT) and C-reactive protein (CRP) in patients treated with mild hypothermia after cardiac arrest, and to study their association to severe infections, post cardiac arrest syndrome (PCAS) and long-term outcome.
  
  
  METHODS
  Serum samples from cardiac arrest patients treated with mild hypothermia were collected serially at admission, 2, 6, 12, 24, 36, 48 and 72 h after cardiac arrest. PCT and CRP concentrations were determined and tested for association with three definitions of infection, two surrogate markers of PCAS (circulation-SOFA and time to return of spontaneous circulation (ROSC)) and cerebral performance category (CPC) at six months.
  
  
  RESULTS
  Eighty-four patients were included. PCT displayed an earlier release pattern than CRP with a significant increase within 2h, increasing further at 6h and onwards in patients with poor outcome. CRP increased later and continued to rise during the study period. PCT was strongly associated with circulation-SOFA and time to ROSC, and predicted a poor neurologic outcome with high accuracy (area under the receiver operating characteristic curve of 0.88, 0.86 and 0.87 at 12, 24 and 48 h respectively). No association of PCT or CRP to infection was observed.
  
  
  CONCLUSIONS
  Our results suggest that PCT is released early after resuscitation following cardiac arrest, is associated with markers of PCAS but not with infection, and is an accurate predictor of poor outcome. Validation of these findings in larger studies is warranted.
authors: Department of Intensive and Perioperative Care, Lund University, Skåne University Hospital, Sweden. martin.annborn@skane.se
authors: Martin
authors: M
authors: Annborn
authors: Josef
authors: J
authors: Dankiewicz
authors: David
authors: D
authors: Erlinge
authors: Sabine
authors: S
authors: Hertel
authors: Malin
authors: M
authors: Rundgren
authors: J Gustav
authors: JG
authors: Smith
authors: Joachim
authors: J
authors: Struck
authors: Hans
authors: H
authors: Friberg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000150:complications / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D015427:Reperfusion Injury / Q000097:blood* / Q000150:complications; D012720:Severity of Illness Index; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide