{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:13:06Z","timestamp":1792069986314,"version":"4.4.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2018,1,17]],"date-time":"2018-01-17T00:00:00Z","timestamp":1516147200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2018,1,17]],"date-time":"2018-01-17T00:00:00Z","timestamp":1516147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The objective of this study is to explore whether procalcitonin (PCT) can serve as an early biomarker of malignant cerebral edema in patients with massive cerebral infarction (MCI). Ninety-three patients with acute MCI were divided into death or survival groups based on whether they died or survived within 1 week of cerebral herniation. Differences in laboratory parameters between these two groups were analyzed by univariate analysis, followed by multivariate logistic regression analyses if the influencing factors were significantly different. Compared with the survival group, the patients in the death group had a larger cerebral infarct area, higher body temperature, neutrophil counts, PCT level, and neuron-specific enolase (NSE) level within 48\u2009h of onset. Multivariate logistic regression analyses revealed an odds ratio (OR) of 1.830 or 1.235 for PCT and neutrophil counts respectively, suggesting that PCT and neutrophil counts are two independent risk factors for death in MCI. The area under receiver operating characteristic (ROC) curve was 0.754 for PCT, larger than that for neutrophil counts. Thus, both serum PCT levels and neutrophil counts can be used as biomarkers to predict malignant cerebral edema at the early stages after MCI, but PCT levels are superior predictors of malignant cerebral edema.<\/jats:p>","DOI":"10.1038\/s41598-018-19267-4","type":"journal-article","created":{"date-parts":[[2018,1,11]],"date-time":"2018-01-11T16:09:00Z","timestamp":1515686940000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Procalcitonin as a Biomarker for Malignant Cerebral Edema in Massive Cerebral Infarction"],"prefix":"10.1038","volume":"8","author":[{"given":"Yan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehana K.","family":"Leak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guodong","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2018,1,17]]},"reference":[{"key":"19267_CR1","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1007\/s001340050625","volume":"24","author":"J Berrouschot","year":"1998","unstructured":"Berrouschot, J., Sterker, M., Bettin, S., Koster, J. & Schneider, D. Mortality of space-occupying (\u2018malignant\u2019) middle cerebral artery infarction under conservative intensive care. Intensive Care Med 24, 620\u2013623 (1998).","journal-title":"Intensive Care Med"},{"key":"19267_CR2","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/S1474-4422(07)70036-4","volume":"6","author":"K Vahedi","year":"2007","unstructured":"Vahedi, K. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6, 215\u2013222, https:\/\/doi.org\/10.1016\/S1474-4422(07)70036-4 (2007).","journal-title":"Lancet Neurol"},{"key":"19267_CR3","doi-asserted-by":"publisher","first-page":"2518","DOI":"10.1161\/STROKEAHA.107.485649","volume":"38","author":"E Juttler","year":"2007","unstructured":"Juttler, E. et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 38, 2518\u20132525, https:\/\/doi.org\/10.1161\/STROKEAHA.107.485649 (2007).","journal-title":"Stroke"},{"key":"19267_CR4","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1038\/nrneurol.2012.98","volume":"8","author":"A Chamorro","year":"2012","unstructured":"Chamorro, A. et al. The immunology of acute stroke. Nat Rev Neurol 8, 401\u2013410, https:\/\/doi.org\/10.1038\/nrneurol.2012.98 (2012).","journal-title":"Nat Rev Neurol"},{"key":"19267_CR5","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1111\/j.1365-2796.2006.01694.x","volume":"260","author":"R Leira","year":"2006","unstructured":"Leira, R. et al. Hyperthermia is a surrogate marker of inflammation-mediated cause of brain damage in acute ischaemic stroke. J Intern Med 260, 343\u2013349, https:\/\/doi.org\/10.1111\/j.1365-2796.2006.01694.x (2006).","journal-title":"J Intern Med"},{"key":"19267_CR6","doi-asserted-by":"publisher","first-page":"2003","DOI":"10.1007\/s00415-009-5228-x","volume":"256","author":"HM den Hertog","year":"2009","unstructured":"den Hertog, H. M. et al. C-reactive protein in the very early phase of acute ischemic stroke: association with poor outcome and death. J Neurol 256, 2003\u20132008, https:\/\/doi.org\/10.1007\/s00415-009-5228-x (2009).","journal-title":"J Neurol"},{"key":"19267_CR7","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1161\/STROKEAHA.115.011392","volume":"47","author":"M Katan","year":"2016","unstructured":"Katan, M. et al. Procalcitonin and Midregional Proatrial Natriuretic Peptide as Markers of Ischemic Stroke: The Northern Manhattan Study. Stroke 47, 1714\u20131719, https:\/\/doi.org\/10.1161\/STROKEAHA.115.011392 (2016).","journal-title":"Stroke"},{"key":"19267_CR8","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1161\/STROKEAHA.110.607432","volume":"42","author":"SJ Kim","year":"2011","unstructured":"Kim, S. J., Choe, Y. H. & Bang, O. Y. & Collaborators, C.-B. Are stroke biomarkers seeing brain vessels in patients with ischemic stroke?: a C-reactive protein and homocysteine study. Stroke 42, 1464\u20131468, https:\/\/doi.org\/10.1161\/STROKEAHA.110.607432 (2011).","journal-title":"Stroke"},{"key":"19267_CR9","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.jns.2015.03.032","volume":"352","author":"YM Li","year":"2015","unstructured":"Li, Y. M. & Liu, X. Y. Serum levels of procalcitonin and high sensitivity C-reactive protein are associated with long-term mortality in acute ischemic stroke. J Neurol Sci 352, 68\u201373, https:\/\/doi.org\/10.1016\/j.jns.2015.03.032 (2015).","journal-title":"J Neurol Sci"},{"key":"19267_CR10","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.jocn.2013.06.015","volume":"21","author":"RL VanGilder","year":"2014","unstructured":"VanGilder, R. L. et al. C-reactive protein and long-term ischemic stroke prognosis. J Clin Neurosci 21, 547\u2013553, https:\/\/doi.org\/10.1016\/j.jocn.2013.06.015 (2014).","journal-title":"J Clin Neurosci"},{"key":"19267_CR11","first-page":"114","volume":"35","author":"K Tamaki","year":"2008","unstructured":"Tamaki, K. et al. Diagnostic accuracy of serum procalcitonin concentrations for detecting systemic bacterial infection in patients with systemic autoimmune diseases. J Rheumatol 35, 114\u2013119 (2008).","journal-title":"J Rheumatol"},{"key":"19267_CR12","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s12291-013-0382-4","volume":"29","author":"N Verma","year":"2014","unstructured":"Verma, N., Kapoor, S., Rao, D., Sharma, S. & Arora, A. PCT as a Prognostic Marker in Cardiac Patients with Neutropenic Sepsis: Two Case Reports. Indian J Clin Biochem 29, 107\u2013111, https:\/\/doi.org\/10.1007\/s12291-013-0382-4 (2014).","journal-title":"Indian J Clin Biochem"},{"key":"19267_CR13","doi-asserted-by":"publisher","first-page":"e48309","DOI":"10.1371\/journal.pone.0048309","volume":"7","author":"F Fluri","year":"2012","unstructured":"Fluri, F., Morgenthaler, N. G., Mueller, B., Christ-Crain, M. & Katan, M. Copeptin, procalcitonin and routine inflammatory markers-predictors of infection after stroke. PLoS One 7, e48309, https:\/\/doi.org\/10.1371\/journal.pone.0048309 (2012).","journal-title":"PLoS One"},{"key":"19267_CR14","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.cccn.2004.08.002","volume":"350","author":"S Miyakis","year":"2004","unstructured":"Miyakis, S. et al. Serial serum procalcitonin changes in the prognosis of acute stroke. Clin Chim Acta 350, 237\u2013239, https:\/\/doi.org\/10.1016\/j.cccn.2004.08.002 (2004).","journal-title":"Clin Chim Acta"},{"key":"19267_CR15","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1007\/s10571-014-0131-0","volume":"35","author":"WJ Deng","year":"2015","unstructured":"Deng, W. J., Shen, R. L., Li, M. & Teng, J. F. Relationship between procalcitonin serum levels and functional outcome in stroke patients. Cell Mol Neurobiol 35, 355\u2013361, https:\/\/doi.org\/10.1007\/s10571-014-0131-0 (2015).","journal-title":"Cell Mol Neurobiol"},{"key":"19267_CR16","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1007\/s12035-015-9112-7","volume":"53","author":"C Wang","year":"2016","unstructured":"Wang, C. et al. Procalcitonin Is a Stronger Predictor of Long-Term Functional Outcome and Mortality than High-Sensitivity C-Reactive Protein in Patients with Ischemic Stroke. Mol Neurobiol 53, 1509\u20131517, https:\/\/doi.org\/10.1007\/s12035-015-9112-7 (2016).","journal-title":"Mol Neurobiol"},{"key":"19267_CR17","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1007\/s12028-014-0085-6","volume":"22","author":"MT Torbey","year":"2015","unstructured":"Torbey, M. T. et al. Evidence-based guidelines for the management of large hemispheric infarction: a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine. Neurocrit Care 22, 146\u2013164, https:\/\/doi.org\/10.1007\/s12028-014-0085-6 (2015).","journal-title":"Neurocrit Care"},{"key":"19267_CR18","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","volume":"24","author":"HP Adams Jr","year":"1993","unstructured":"Adams, H. P. Jr et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24, 35\u201341 (1993).","journal-title":"Stroke"},{"key":"19267_CR19","doi-asserted-by":"publisher","first-page":"89","DOI":"10.3233\/THC-2010-0571","volume":"18","author":"C Haasper","year":"2010","unstructured":"Haasper, C. et al. Prognostic value of procalcitonin (PCT) and\/or interleukin-6 (IL-6) plasma levels after multiple trauma for the development of multi organ dysfunction syndrome (MODS) or sepsis. Technol Health Care 18, 89\u2013100, https:\/\/doi.org\/10.3233\/THC-2010-0571 (2010).","journal-title":"Technol Health Care"},{"key":"19267_CR20","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1177\/0310057X0403200402","volume":"32","author":"E Oconnor","year":"2004","unstructured":"Oconnor, E. et al. Serum procalcitonin and C-reactive protein as markers of sepsis and outcome in patients with neurotrauma and subarachnoid haemorrhage. Anaesth Intensive Care 32, 465\u2013470 (2004).","journal-title":"Anaesth Intensive Care"},{"key":"19267_CR21","first-page":"4242","volume":"8","author":"YM Li","year":"2016","unstructured":"Li, Y. M. & Liu, X. Y. Molecular mechanisms underlying application of serum procalcitonin and stool miR-637 in prognosis of acute ischemic stroke. Am J Transl Res 8, 4242\u20134249 (2016).","journal-title":"Am J Transl Res"},{"key":"19267_CR22","doi-asserted-by":"publisher","first-page":"631062","DOI":"10.1155\/2011\/631062","volume":"2011","author":"P Stammet","year":"2011","unstructured":"Stammet, P. et al. Assessment of procalcitonin to predict outcome in hypothermia-treated patients after cardiac arrest. Crit Care Res Pract 2011, 631062, https:\/\/doi.org\/10.1155\/2011\/631062 (2011).","journal-title":"Crit Care Res Pract"},{"key":"19267_CR23","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1161\/hs0901.095719","volume":"32","author":"SE Kasner","year":"2001","unstructured":"Kasner, S. E. et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 32, 2117\u20132123 (2001).","journal-title":"Stroke"},{"key":"19267_CR24","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1001\/jama.279.18.1477","volume":"279","author":"J Danesh","year":"1998","unstructured":"Danesh, J., Collins, R., Appleby, P. & Peto, R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 279, 1477\u20131482 (1998).","journal-title":"JAMA"},{"key":"19267_CR25","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.ehj.2004.05.002","volume":"25","author":"JG Wheeler","year":"2004","unstructured":"Wheeler, J. G., Mussolino, M. E., Gillum, R. F. & Danesh, J. Associations between differential leucocyte count and incident coronary heart disease: 1764 incident cases from seven prospective studies of 30,374 individuals. Eur Heart J 25, 1287\u20131292, https:\/\/doi.org\/10.1016\/j.ehj.2004.05.002 (2004).","journal-title":"Eur Heart J"},{"key":"19267_CR26","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1097\/COH.0b013e32833ed177","volume":"5","author":"K Strimbu","year":"2010","unstructured":"Strimbu, K. & Tavel, J. A. What are biomarkers? Curr Opin HIV AIDS 5, 463\u2013466, https:\/\/doi.org\/10.1097\/COH.0b013e32833ed177 (2010).","journal-title":"Curr Opin HIV AIDS"},{"key":"19267_CR27","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1067\/mcp.2001.113989","volume":"69","author":"Biomarkers Definitions Working","year":"2001","unstructured":"Biomarkers Definitions Working. G. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther 69, 89\u201395, https:\/\/doi.org\/10.1067\/mcp.2001.113989 (2001).","journal-title":"Clin Pharmacol Ther"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-19267-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-19267-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-19267-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T01:08:53Z","timestamp":1671584933000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-19267-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,17]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["19267"],"URL":"https:\/\/doi.org\/10.1038\/s41598-018-19267-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,17]]},"assertion":[{"value":"8 August 2017","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 December 2017","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 January 2018","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"993"}}