Abstracts

Rationale: Acute-phase proteins, such as procalcitonin (PCT), C-reactive protein (CRP) and albumin, may relate with course and outcome in status epilepticus (SE), as ongoing seizures may 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 death in adult patients with SE. Furthermore, we sought to compare the predictive value of PCT, CRP and albumin for death.Methods: Observational cohort study at an academic tertiary medical care center. From 2005 to 2012, all three acute-phase proteins were assessed at entry in adult patients admitted for treatment of SE . Death during hospital stay and 90 days after SE onset was considered as the primary and infections during SE as the secondary outcome.Results: In 91 SE patients, 90-day mortality was 23.1%. Infections (affecting the respiratory tract in 85.7%) emerged in 30.8%. In multivariable analysis, PCT predicted death independently from possible confounders such as acute etiology, the Charlson Comorbidity Index, and the Status Epilepticus Severity Score (STESS) (relative risk 1.2 per every increasing microgram of PCT per liter, 95%CI 1.14-1.37). Additional multivariable analysis including PCT, CRP and albumin revealed PCT as the only biomarker independently associated with an increased relative risk (RR) for death. Procalcitonin levels at SE onset were not related with the occurrence of infections during SE.Conclusions: Serum PCT measured at SE onset is independently associated with death but does not predict 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.