Abstracts

Rationale: Infections in status epilepticus (SE) patients result in severe morbidity making early diagnosis crucial. SE patients are especially at risk for ventilator-associated pneumonia (VAP) due to the need of mechanical ventilation during their state of altered consciousness. Therefore, early and accurate diagnosis of these complications is important. Procalcitonin (PCT) is a pre-pro-peptide precursor of the thyroid hormone calcitonin. Circulating levels of the PCT can rise several thousand times above normal under various inflammatory conditions, but most notably if caused by bacterial infections. As PCT is a valid complementary diagnostic marker and an important tool for treatment monitoring of VAP or other infectious complications, it may be a promising marker for rapid detection of these complications during SE in the intensive care unit (ICU). However, SE itself may lead to systemic inflammatory reaction with increase of cytokines in serum during or immediately after epileptic seizures. Epileptic activity itself may lead to an increase of PCT, C-reactive protein (CRP) and white blood cells (WBC) and reduce the reliability of these biomarkers for the clinical diagnosis of infectious complications during SE. We examined the reliability of PCT, CRP and WBC for early diagnosis of infections during SE. Methods: This observational cohort study was performed on the ICU of a tertiary care center. All patients with SE treated on the ICU from 2005 to 2009 from whom electroencephalograms, clinical and microbiological records, and measurements of PCT, CRP and WBC were available during the first 48 hours of SE were included. A comprehensive review of medical records and clinical data was performed by a board certified neurologist [R.S.] and by an infectious diseases specialist [S.T.S.]. Data collection included gender, age, all medical diagnoses, duration of SE, hospital stay, and ICU stay. Results: Full data was available from 31 patients with SE. 18 (58.1%) had infections with respiratory tract infections being most frequent (48.4%). CSE was present in 6 (19.4%), NCSE in 25 (80.6%) patients and in 16 (51.6%) SE was refractory to first line treatment, i.e. RSE (Table 1). Mean SE duration was 2.8 days ( 3.9), mean stay on the ICU was 11.5 days ( 9.9) and mean duration of hospitalization was 21.4 days ( 21.5). Levels of PCT, CRP and WBC did not differ significantly in patients with and without infections during SE. Sensitivity of PCT and CRP was high (94.4%, 83.3%, respectively). However, specificity was low (15.4% for both), which did not considerably improve with different cut-off values (Figure 1).Conclusions: Low levels of PCT and CRP are important factors to rule out hospital-acquired infections in SE patients. Elevation of these parameters during SE episodes did not point to underlying infections. To diagnose an infectious complication during SE thorough clinical assessment is crucial.