Can Procalcitonin Be Used as a Reliable Marker for Infectious Fever in Patients with Intracranial Hemorrhage?

Objective: To determine whether procalcitonin (PCT) levels are different in infected versus noninfected febrile patients with intracranial hemorrhage (ICH). Methods: This prospective observational study included 104 patients with ICH and fever >38.3°C admitted to the intensive care unit of a tertiary care hospital. PCT was measured on day 1 (PCT 1) of fever and 48–72 hours later (PCT 2). Patients were determined to have an infection (pneumonia, urinary tract infection, or bacteremia) based on cultures, imaging, and clinical impression of treating clinicians. Results: Analysis of variance indicated significant mean differences in patients with no, probable, and definite infection (F_2,103 = 3.12, P = 0.048) between PCT 1 and PCT 2 (F_2,72 = 4.64, P = 0.013). Patients with probable infection had the highest PCT 1 (mean = 0.47, SD = 0.93), and patients with definite infection had higher PCT 2 (mean = 0.62, SD = 0.85). Additional analyses of univariable mean differences showed mean PCT 1 that was significantly higher in the probable infection group compared with the no infection group. Mean PCT was significantly higher at both time points in the definite infection group compared with the no infection group. There were no significant differences between the probable and definite infection groups. Conclusions: PCT levels were higher in patients with ICH and infections and may be a useful marker to differentiate between infectious and noninfectious etiologies of fevers in these patients. Further studies, including randomized controlled trials, will help in establishing the utility of this marker in optimal management of febrile patients with ICH.