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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Predictive value of intrathecal Interleukin-6 for ventriculostomy-related infection

Vorhersagewert des intrathekalen Interleukin-6 für Meningitiden bei externer Liquorableitung

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  • corresponding author B. Schoch - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • J. Regel - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • O. Mueller - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • M. Wichert - Institut für Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Essen
  • D. Stolke - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.05.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc044.shtml

Published: April 11, 2007

© 2007 Schoch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Early diagnosis of ventriculostomy-related infection (VRI) is crucial for the early treatment and course of this disease. In neurosurgical patients, diagnostic criteria are equivocal and non-specific, mostly because of bloodstained cerebrospinal fluid (CSF). The predictive value, sensitivity and specificity of intrathecal interleukin-6 (IL-6CSF) have been proven for VRI compared with classical diagnostic CSF parameters, i.e. cell countCSF (CCCSF) and total proteinCSF.

Methods: We prospectively analysed the daily clinical data and CSF samples of 75 neurosurgical patients with an external ventricular drainage (EVD), which had been inserted predominantly because of poor-grade subarachnoid haemorrhage (SAH). The intrathecal interleukin-6 concentrations (IL-6CSF) were correlated with the clinical course and VRI incidence, as diagnosed by the classical VRI criteria (cellcountCSF, total proteinCSF, clinical symptoms).

Results: Based on classical criteria, bacterial meningitis occurred in 26.7% of patients. Patients with VRI manifested significantly (p<0.001) higher median values of IL-6CSF (up to 2000-fold increase) the day before (day -1) infection was diagnosed by conventional parameters. Using a cut-off value of IL-6CSF≥2700 pg/ml on day - 1, the relative risk for VRI was 6.09 (95% CI: 2.62% - 14.18%). A predictive value of IL-6CSF≥2700 pg/ml for VRI was calculated to be 89% (95% CI: 79.6% - 98.0%), sensitivity 73.7% and specificity 91.4%. The amount of intrathecal blood was an independent risk factor for VRI occurrence, whereas the mean duration of EVD in place showed no impact on the rate of infection.

Conclusions: Our data indicate that IL-6CSF is a reliable marker for predicting VRI, prior to clinically manifest meningitis, one day earlier than the common diagnostic criteria of CSF infection (CCCSF, total proteinCSF, clinical symptoms).