Procalcitonin as a biomarker of nosocomial pneumonia in aneurysmal subarachnoid hemorrhage patients treated in neuro-ICU.

BACKGROUND: Nosocomial pneumonia commonly develops in aneurysmal subarachnoid hemorrhage (aSAH) patients and is associated with poor prognosis of these patients. This study is designed to verify the predictive value of procalcitonin (PCT) on nosocomial pneumonia in aSAH patients. METHODS: 298 aSAH patients received treatments in the neuro-intensive care unit (NICU) of West China hospital were included. Logistic regression was conducted to verify the association between PCT level and nosocomial pneumonia and to construct a model for predicting pneumonia. Area under the receiver operating characteristic curve (AUC) were calculated to evaluate the accuracy of the single PCT and the constructed model. RESULTS: 90 (30.2%) patients developed pneumonia during hospitalizations among included aSAH patients. Pneumonia group had higher procalcitonin level (p < 0.001) than non-pneumonia group. The mortality (p < 0.001), mRS (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (p < 0.001) were both higher or longer in pneumonia group. Multivariate logistic regression indicated WFNS (p = 0.001), acute hydrocephalus (p = 0.007), WBC (p = 0.021), PCT (p = 0.046) and C-reactive protein (CRP) (p = 0.031) were independently associated with the development of pneumonia in included patients. The AUC value of procalcitonin for predicting nosocomial pneumonia was 0.764. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, the predictive model for pneumonia has higher AUC of 0.811. CONCLUSIONS: PCT is an available and effective predictive marker of nosocomial pneumonia in aSAH patients. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, our constructed predictive model is helpful for clinicians to evaluate the risk of nosocomial pneumonia and guide therapeutics in aSAH patients.