title: Procalcitonin and mortality in status epilepticus: an observational cohort study.
abstract: BACKGROUND
  Acute-phase proteins, such as procalcitonin (PCT), C-reactive protein (CRP) and albumin, may relate with course and outcome in status epilepticus (SE), as seizures bring about inflammation, changes of cytokine levels and blood-brain barrier breakdown. We aimed to determine the predictive value of serum levels of PCT at SE onset for the emergence of infections and unfavorable outcome in adult patients with SE. Furthermore, we sought to compare the predictive value of PCT, CRP and albumin for death.
  
  
  METHODS
  This observational cohort study was performed in the intensive care units of the University Hospital Basel (Switzerland), a university-affiliated tertiary care center. Adult patients with SE admitted from 2005 to 2012 were included. Serum levels of PCT, CRP and albumin were assessed at SE onset. Unfavorable outcome (i.e., death and a Glasgow Outcome Score of 1 to 3) during hospital stay and mortality after 30 days were considered the primary and infections as the secondary outcome measures.
  
  
  RESULTS
  In 91 SE patients, mortality was 23.1 % during hospital stay and at 30-days follow-up. Infections emerged in 30.8 % of patients. In the multivariable analysis, PCT predicted unfavorable outcome independently from possible confounders such as acute etiology, infections during SE, the Charlson Comorbidity Index, and the Status Epilepticus Severity Score (hazard ratio 1.44 per every increasing ug/L, 95 % confidence interval 1.11-1.87). Additional multivariable analysis including serum levels of PCT, CRP and albumin revealed PCT as the only biomarker independently associated with an increased hazard for unfavorable outcome. PCT levels at SE onset were not related to infections during SE.
  
  
  CONCLUSIONS
  Serum PCT levels measured at SE onset are independently associated with unfavorable outcome but do not predict the emergence of infections during SE. Procalcitonin may increase the predictive value of clinical scoring systems allowing for rapid risk stratification early in the course of SE.
authors.affiliation: Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland. raoul.sutter@usb.ch.|Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland. raoul.sutter@usb.ch.
authors.forename: Raoul
authors.initials: R
authors.lastname: Sutter
authors.affiliation: University of Basel, Basel, Switzerland. m.valenca@stud.unibas.ch.
authors.forename: Martina
authors.initials: M
authors.lastname: Valença
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. sarah.tschudin@usb.ch.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tschudin-Sutter
authors.affiliation: Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland. stephan.rueegg@usb.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Rüegg
authors.affiliation: Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland. stephan.marsch@usb.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide