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Open Access Research

Acute phase proteins and white blood cell levels for prediction of infectious complications in status epilepticus

Raoul Sutter12*, Sarah Tschudin-Sutter3, Leticia Grize4, Andreas F Widmer3, Stephan Marsch2 and Stephan Rüegg1

Author Affiliations

1 Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Peterplatz 1, Basel, 4003, Switzerland

2 Intensive Care Unit, University Hospital Basel, Peterplatz 1, Basel, 4003, Switzerland

3 Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Peterplatz 1, Basel, 4003 Switzerland

4 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, 4002, Switzerland

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Critical Care 2011, 15:R274  doi:10.1186/cc10555

Published: 18 November 2011

Abstract

Introduction

Infections in status epilepticus (SE) patients result in severe morbidity making early diagnosis crucial. As SE may lead to inflammatory reaction, the value of acute phase proteins and white blood cells (WBC) for diagnosis of infections during SE may be important. We examined the reliability of C-reactive protein (CRP), procalcitonin (PCT), and WBC for diagnosis of infections during SE.

Methods

All consecutive SE patients treated in the ICU from 2005 to 2009 were included. Clinical and microbiological records, and measurements of CRP and WBC during SE were analyzed. Subgroup analysis was performed for additional PCT measurements in the first 48 hours of SE.

Results

A total of 22.5% of 160 consecutive SE patients had infections during SE. Single levels of CRP and WBC had no association with the presence of infections. Their linear changes over the first three days after SE onset were significantly associated with the presence of infections (P = 0.0012 for CRP, P = 0.0137 for WBC). Levels of PCT were available for 31 patients and did not differ significantly in patients with and without infections. Sensitivity of PCT and CRP was high (94% and 83%) and the negative predictive value of CRP increased over the first three days to 97%. Specificity was low, without improvement for different cut-offs.

Conclusions

Single levels of CRP and WBC are not reliable for diagnosis of infections during SE, while their linear changes over time significantly correlate with the presence of infections. In addition, low levels of CRP and PCT rule out hospital-acquired infections in SE patients.