J Neurocrit Care.  2022 Jun;15(1):21-31. 10.18700/jnc.210031.

Use of temperature changes and pro-inflammatory biomarkers to diagnose bacterial infections in patients with severe cerebral trauma

• Toros A
• Grodzinsky E
• Karlsson N
• Nilsson M
• Levander MS

• KMID: 2531996
• DOI: http://doi.org/10.18700/jnc.210031

Abstract

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 neurosurgery 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.

Keyword

Infection; Fever; DiffTemp; Trauma; Body temperature; Midregional proadrenomedullin

Figure

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  Fig. 1. The average care time at the neurosurgical intensive care unit where the study was performed.

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  Fig. 2. Boxplots of (A) high-sensitivity C-reactive protein (hs-CRP), (B) white blood cell (WBC), (C) procalcitonin, (D) midregional proadrenomedullin (MR-proADM) levels, and (E) body temperature by infection group. The boxes represent the interquartile ranges (25th to 75th percentiles), the thick black line in the box is the 50th percentile (median), and the bars represent the range of results, excluding outliers. Circles are "outliers" and asterisks are "extreme outliers." No infection, n=11; suspected infection, n=15; confirmed infection, n=16. Two patients were excluded from Fig. 2C (group 2) due to extreme outliers affecting the readability of the figure. Analyzed using the independent-samples Kruskal-Wallis test.

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  Fig. 3. High-sensitivity C-reactive protein (hs-CRP) levels displayed over time during hospital stay in 42 patients in the neurosurgical intensive care unit.

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  Fig. 4. Mean high-sensitivity C-reactive protein (hs-CRP) levels over time across the categories of infection. No infection, n=11; suspected infection, n=15; confirmed infection, n=16.

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  Fig. 5. Bar graph of the different infection groups that were organized by temperature change (defined by DiffTemp, i.e., having or not having an individual increase of >1°C) during hospital stay.

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