A comparative study on the use of procalcitonin to distinguish between central fever and infectious causes of fever

Abstract

Introduction: central fever is defined as elevated body temperature without any evidence of infection or drug reaction fever, and currently it has no definitive diagnostic criteria. The current study aims to assess the role of procalcitonin (PCT) in differentiating central fever from fever secondary to infections in patients with neurological insults.

Methods: we conducted a retrospective study of patients admitted with a neurological insult (brain trauma, brain tumors and cerebrovascular accidents) in a tertiary care hospital. All patients who developed fever 48 hours after admission and had procalcitonin, C-reactive protein (CRP), and Erythrocyte sedimentation rate (ESR) done as part of fever evaluation were assessed to include in the study.

Results: out of 70 patients who met inclusion criteria, 37 had infections identified and 33 had no source of infection. The mean age was 42.9 years (± 18) in the infectious group while 40.3 years (± 18.2) in the central fever group and there was male predominance in both groups. In the infectious group there were 25(67.6%) males vs. 12(32.4%) females while in non -infectious group, males vs. females were 18(54.5%) vs. 15(45.5%) and there was no difference in both group (p-value 0.26) Median procalcitonin (PCT) value was 0.09 ng/dl (IQR 0.05- 0.19) in patients with no identified cause of infection and 1.4 ng/dl (IQR 0.5-5.1) in patients with infections with a p-value of <0.001. Although CRP and ESR were low in patients with central fever as compared to those with infections, these differences did not reach statistical significance with p-value of CRP 0.18 and p-value of ESR 0.31 between two groups.

Conclusion: PCT levels were low in patients with central fever and may be considered as a useful biomarker to differentiate between infectious fever from non-infectious fever in patients with brain injury. This can prevent unnecessary antibiotic use in patients without infection.

Keywords: Procalcitonin; central nervous system; fever; infections; stroke.

Figure 1

procalcitonin as a predictor for infection