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KMID : 1201420220150010021
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Journal of Neurocritical Care
2022 Volume.15 No. 1 p.21 ~ p.31
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Use of temperature changes and pro-inflammatory biomarkers to diagnose bacterial infections in patients with severe cerebral trauma
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Toros Andrew
Grodzinsky Ewa
Karlsson Nadine
Nilsson Martin
Levander Marta Sund
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Abstract
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Background: In patients undergoing neurosurgeries, inflammation and infection are strongly related; however, inflammation can be present without infection. Midregional proadrenomedullin (MR-proADM) is a relatively new sepsis biomarker that is rarely used clinically. Recently, the concept of DiffTemp was introduced, that is, a >1°C rise from individual normal temperature accompanied by malaise, as a more accurate definition of temperature assessed as fever. The aim of the present study was to examine the importance of C-reactive protein (CRP), white blood cells, procalcitonin, and MR-proADM levels and DiffTemp.
Methods: This prospective, comparative study had a quantitative approach. Forty-two patients, aged >18 years and presenting with severe cerebral trauma were included from a neurosurgical intensive care unit. The outcome variable was infection; group 0, no infection (n=11); group 1, suspected infection (n=15); and, group 2, confirmed infection (n=16). Group assignments were performed using biomarkers, medical records, bacterial cultures, and International Classification of Diseases-10, and by the clinical assessment of criteria for nosocomial infections by a neurosurgeon.
Results: On comparing groups 1 and 2, MR-proADM and DiffTemp were associated with a higher risk of confirmed infection (odds ratio, 5.41 and 17.14, respectively). Additionally, DiffTemp had a 90.9% specificity in patients with no infection and a 93.8% sensitivity in patients with confirmed infections. CRP and procalcitonin levels were not associated with an increased risk of confirmed infection.
Conclusion: Increased levels of MR-proADM were associated with a higher risk of confirmed infection. DiffTemp was associated with a higher risk of having a confirmed infection.
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KEYWORD
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Infection, Fever, DiffTemp, Trauma, Body temperature, Midregional proadrenomedullin
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