Procalcitonin-guided antibiotic treatment of stroke-associated pneumonia after spontaneous intracerebral hemorrhage: a randomized controlled trial

Objective To investigate the guiding value of serum procalcitonin (PCT) level in antibiotic treatment of stroke-associated pneumonia (SAP) after spontaneous intracerebral hemorrhage. Methods A total of 120 patients with SAP after acute cerebral hemorrhage were enrolled and were randomly divided into either a conventional treatment group (n=59) or a PCT guided group (n=61). In accordance with the guidelines for the use of antibiotics in China, the conventional treatment group was treated with antibiotics and the course of antibiotics was determined by the treating physician. The serum PCT of the PCT group was monitored continuously after using antibiotics for 5 days. When PCT was 2 was poor outcome. They were followed up for 6 months after discharge. A Kaplan-Meier survive curve was use to compare the survival rate of both groups. Results The course of antibiotics (8.95±2.73 d vs. 13.26±4.11 d; t=6.407, P<0.001) and the length of hospitalization (15.64±2.63 d vs. 18.36±4.27 d; t=3.967, P<0.001) of the PCT group were significantly shorter than those of the conventional treatment group. There were no significant differences in the proportions of 30 d mortality (9.8% vs. 10.1%; χ2=0.003, P=0.951) and 90 d good outcome (60.6% vs. 59.3%; χ2=0.022, P=0.881) between the PCT guided group and the conventional treatment group. At the end of the 6-month follow-up period, a total of 13 patients (12.0%) died, including 6 in the conventional treatment group and 7 in the PCT group. The Kaplan-Meier analysis showed that there was no significant difference in the 6-month survival rate between the 2 groups (χ2=0.070, P=0.791). Conclusions Monitoring the serum PCT level for guiding antibiotic treatment of SAP after spontaneous intracerebral hemorrhage is safe, and it may shorten the course of antibiotics and reduce the length of hospitalization. Key words: Cerebral Hemorrhage; Pneumonia; Calcitonin; Anti-Bacterial Agents; Treatment Outcome; Procalcitonin