Procalcitonin as a diagnostic marker in patients with aspiration after closed head injury

Background: Aspiration of gastric content frequently induces early onset of pneumonia in patients with impaired consciousness after closed head injury and thus worsens the prognosis. Early detection of aspiration and appropri ate therapy are essential. The purpose of the study was to assess the diagn ostic value of procalcitonin (ProCT) in aspiration of gastric content and t o evaluate its prognostic impact in patients with closed head injury. Methods: Twenty-three patients with isolated closed head injury (Glasgow Co ma Scale [GCS] score less than or equal to 8) were studied. Bronchoscopy wa s done on admission; chest radiographs and routine laboratory examination i ncluding C-reactive protein were performed daily. ProCT was analyzed 12, 24 , 36 and 72 hours after trauma using an immunoluminometric assay. Results: ProCT was higher throughout the study period in 9 patients with pe rsistent radiological signs suspect for aspiration of gastric content and t here was evidence of aspiration of gastric content during bronchoscopy on a dmission. Median ProCT values of 1.397 ng/ml (range, 0.372 to 8.358 ng/ml) on admission increased to 2.144 ng/ml (range, 0.716 to 6.910 ng/ml) 24 hour s after trauma, and then decreased to baseline values of 1.711 ng/ml (range , 0.611 to 6.639 ng/ml) as early as 36 hours after trauma. In patients with out signs of aspiration of gastric content, ProCT values did not exceed 0.4 18 ng/ml. Non-survivors had higher serum levels of ProCT throughout the stu dy period. Conclusion: Our findings suggest that ProCT is a useful diagnostic marker f or detecting aspiration of gastric content while the prognostic value of Pr oCT for predicting survival after isolated closed head injury was moderate.