Association between procalcitonin level and the occurrence of malignant brain edema after acute cerebral infarction_West China Medical Journal

Authors：

LIU Zhiqian ^1,2,3 ,  WANG Lu ^1,2,3 ,  WEI Quan ^1,2,3

1. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu Sichuan 610041, P. R. China;
2. Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu Sichuan 610041, P. R. China;
3. Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu Sichuan 610041, P. R. China;

Corresponding?author：

WANG Lu, Email: wanglu0823@scu.edu.cn; WEI Quan, Email: weiquan@scu.edu.cn

Keywords：

Procalcitonin; malignant brain edema; acute cerebral infarction

DOI：

10.7507/1002-0179.202404035

Video：

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Objective To explore the association between procalcitonin (PCT) level and the development of malignant brain edema (MBE) after acute cerebral infarction. Methods The data on patients with stroke admitted to the Department of Neurology of West China Hospital, Sichuan University between January 1, 2017 and December 31, 2018 were retrospective collected. Patients were divided into MBE group and non-MBE group based on whether MBE had occurred. The basic information and neuroimaging data of two groups of patients were compared and analyzed. Results A total of 798 patients were included. Among them, there were 93 cases of MBE (11.65%) and 705 cases of non-MBE (88.35%). The median time of MBE occurrence (lower quartile, upper quartile) was 29 (24, 54) hours after onset. The difference in the National Institutes of Health Stroke Scale, large-scale middle cerebral artery infarction, dysarthria, low fever, consciousness status, chronic heart failure, TOAST typing, mechanical ventilation, gastric tube placement, PCT on the first and third day of admission between the two groups were statistically significant (P<0.05). There was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that both day 1 PCT and large-scale middle cerebral artery infarction were associated with MBE. Conclusions Elevated PCT within 24 hours from onset is independently associated with the development of MBE after acute cerebral infarction. Patients with elevated PCT after cerebral infarction may require careful clinical management.

Citation： LIU Zhiqian, WANG Lu, WEI Quan. Association between procalcitonin level and the occurrence of malignant brain edema after acute cerebral infarction. West China Medical Journal, 2024, 39(5): 705-710. doi: 10.7507/1002-0179.202404035 Copy

1.	Hacke W, Schwab S, Horn M, et al. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol, 1996, 53(4): 309-315.
2.	Kasner SE, Demchuk AM, Berrouschot J, et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke, 2001, 32(9): 2117-2123.
3.	Michinaga S, Koyama Y. Pathogenesis of brain edema and investigation into anti-edema drugs. Int J Mol Sci, 2015, 16(5): 9949-9975.
4.	Wijdicks EF, Sheth KN, Carter BS, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014, 45(4): 1222-1238.
5.	Zhang Y, Liu G, Wang Y, et al. Procalcitonin as a biomarker for malignant cerebral edema in massive cerebral infarction. Sci Rep, 2018, 8(1): 993.
6.	楊振宇. 降鈣素原與 C 反應蛋白對西寧地區腦梗死繼發腦水腫患者預后的影響. 西寧: 青海大學 , 2022.
7.	季麗平, 張慧和, 陳炳, 等. 急性腦梗塞患者降鈣素原水平與腦水腫嚴重程度的相關性研究. 中國衛生檢驗雜志, 2020, 30(1): 12-14.
8.	陳廣鵬, 苗國印, 楊艷琴. 急性腦梗死患者血清 VEGF、PCT、hs-CRP 表達與腦水腫嚴重程度的關系. 臨床薈萃, 2021, 36(4): 315-318.
9.	Wu S, Yuan R, Wang Y, et al. Early prediction of malignant brain edema after ischemic stroke. Stroke, 2018, 49(12): 2918-2927.
10.	馬蓉, 欒飛, 李茂星, 等. 炎性因子在腦水腫發病機制中的作用. 西北國防醫學雜志, 2015, 36(7): 465-468.
11.	Simard JM, Kent TA, Chen M, et al. Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol, 2007, 6(3): 258-268.
12.	Weisenburger-Lile D, Dong Y, Yger M, et al. Harmful neutrophil subsets in patients with ischemic stroke: association with disease severity. Neurol Neuroimmunol Neuroinflamm, 2019, 6(4): e571.
13.	Ng FC, Churilov L, Yassi N, et al. Microvascular dysfunction in blood-brain barrier disruption and hypoperfusion within the infarct posttreatment are associated with cerebral edema. stroke, 2022, 53(5): 1597-1605.
14.	李佳楠, 李立宏. 缺血性腦卒中后腦水腫的發病機制及治療進展. 臨床醫學進展, 2024, 14(4): 2769-2778.
15.	Miyakis S, Georgakopoulos P, Kiagia M, et al. Serial serum procalcitonin changes in the prognosis of acute stroke. Clin Chim Acta, 2004, 350(1/2): 237-239.
16.	Li YM, Liu XY. Molecular mechanisms underlying application of serum procalcitonin and stool miR-637 in prognosis of acute ischemic stroke. Am J Transl Res, 2016, 8(10): 4242-4249.
17.	Ibrahim F, Menezes S, Buhnerkempe M, et al. Systemic white blood cell count as a biomarker for malignant cerebral edema in large vessel ischemic MCA stroke. J Stroke Cerebrovasc Dis, 2022, 31(8): 106550.

1. Hacke W, Schwab S, Horn M, et al. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol, 1996, 53(4): 309-315.
2. Kasner SE, Demchuk AM, Berrouschot J, et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke, 2001, 32(9): 2117-2123.
3. Michinaga S, Koyama Y. Pathogenesis of brain edema and investigation into anti-edema drugs. Int J Mol Sci, 2015, 16(5): 9949-9975.
4. Wijdicks EF, Sheth KN, Carter BS, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014, 45(4): 1222-1238.
5. Zhang Y, Liu G, Wang Y, et al. Procalcitonin as a biomarker for malignant cerebral edema in massive cerebral infarction. Sci Rep, 2018, 8(1): 993.
6. 楊振宇. 降鈣素原與 C 反應蛋白對西寧地區腦梗死繼發腦水腫患者預后的影響. 西寧: 青海大學 , 2022.
7. 季麗平, 張慧和, 陳炳, 等. 急性腦梗塞患者降鈣素原水平與腦水腫嚴重程度的相關性研究. 中國衛生檢驗雜志, 2020, 30(1): 12-14.
8. 陳廣鵬, 苗國印, 楊艷琴. 急性腦梗死患者血清 VEGF、PCT、hs-CRP 表達與腦水腫嚴重程度的關系. 臨床薈萃, 2021, 36(4): 315-318.
9. Wu S, Yuan R, Wang Y, et al. Early prediction of malignant brain edema after ischemic stroke. Stroke, 2018, 49(12): 2918-2927.
10. 馬蓉, 欒飛, 李茂星, 等. 炎性因子在腦水腫發病機制中的作用. 西北國防醫學雜志, 2015, 36(7): 465-468.
11. Simard JM, Kent TA, Chen M, et al. Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol, 2007, 6(3): 258-268.
12. Weisenburger-Lile D, Dong Y, Yger M, et al. Harmful neutrophil subsets in patients with ischemic stroke: association with disease severity. Neurol Neuroimmunol Neuroinflamm, 2019, 6(4): e571.
13. Ng FC, Churilov L, Yassi N, et al. Microvascular dysfunction in blood-brain barrier disruption and hypoperfusion within the infarct posttreatment are associated with cerebral edema. stroke, 2022, 53(5): 1597-1605.
14. 李佳楠, 李立宏. 缺血性腦卒中后腦水腫的發病機制及治療進展. 臨床醫學進展, 2024, 14(4): 2769-2778.
15. Miyakis S, Georgakopoulos P, Kiagia M, et al. Serial serum procalcitonin changes in the prognosis of acute stroke. Clin Chim Acta, 2004, 350(1/2): 237-239.
16. Li YM, Liu XY. Molecular mechanisms underlying application of serum procalcitonin and stool miR-637 in prognosis of acute ischemic stroke. Am J Transl Res, 2016, 8(10): 4242-4249.
17. Ibrahim F, Menezes S, Buhnerkempe M, et al. Systemic white blood cell count as a biomarker for malignant cerebral edema in large vessel ischemic MCA stroke. J Stroke Cerebrovasc Dis, 2022, 31(8): 106550.

West China Medical Journal

Association between procalcitonin level and the occurrence of malignant brain edema after acute cerebral infarction

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