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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Interleukin-6 in the cerebrospinal fluid as a biomarker for diagnosing vasospasm and ventriculitis in patients with subarachnoid hemorrhage and external ventricular drain

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  • Markus Lenski - Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany
  • Volker Huge - Klinik für Anästhesiologie, Klinikum Großhadern, LMU München, Germany
  • Josef Briegel - Klinik für Anästhesiologie, Klinikum Großhadern, LMU München, Germany
  • Jörg-Christian Tonn - Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany
  • Christian Schichor - Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany
  • Niklas Thon - Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 083

doi: 10.3205/16dgnc458, urn:nbn:de:0183-16dgnc4583

Published: June 8, 2016

© 2016 Lenski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Study aim was to investigate the diagnostic potential of Interleukin 6 (IL-6) as soluble biomarkers in serum and cerebrospinal fluid (CF) of patients with subarachnoid hemorrhage (SAH) and external ventricular drain for differentiation of SAH without complication (SAH-) from SAH with vasospasm (VS) or ventriculitis (VC).

Method: The concentrations of serum biomarkers (sCRP, sIL-6, percentage of neutrophils [sN%]) and markers in the CF (cfIL-6, total leukocyte count [cfTLC], percentage of polymorphonuclear cells [cfPMN%]) were collected in patients with SAH and external ventricular drain. Arithmetical means, area-under-the-curve (AUC), cutoff-values (C-OFF), sensitivity (SE), and specificity (SP) were calculated for biomarkers and their correlation with SAH-, VS and VC.

Results: From the 63 study participants, 19 patients suffered from SAH- alone, 27 patients developed a VS, and 17 a VC after SAH. For the serum biomarkers sN% exhibited highest diagnostic potential for differing between VC (mean 77% ± 7,6, AUC=0,854, C-OFF=72,5%, SE=75%, and SP=100%) and VS (mean 66% ± 7,0%) or SAH- (mean 65,8% ± 4,6%). With respect to the biomarkers in the CF cfIL-6 revealed highest diagnostic potential for differing between VC (7588 ± 4580 pg/ml, AUC=0,852, C-OFF=3081pg/ml, SE=86,7%, and SP=82,1%) and VS (4102 ± 4970 pg/ml) or SAH- (234 ± 239pg/ml). cfIL-6 showed a high diagnostic potential for differing between VC and SAH- alone (AUC=1,00, C-OFF=707, SE=100%, and SP=100%), and a moderate diagnostic potential for differing VS from VC (AUC=0,757, C-OFF=3081pg/ml, SE=86,7%, and SP=70,6%). The concentration of cfIL-6 in the VS group was significantly increased compared to the SAH- group (AUC=0,937, C-OFF=529pg/ml, SE=87,5%, SP=91,7%). The ratio of cfIL-6/sIL-6 was significantly increased in the VC and VS groups, but had lower diagnostic potential than cfIL-6 alone. cfTLC is a good marker for diagnosing VC (2108 ± 2499/µl, AUC=0,810, C-OFF=561/µl, SE=75%, SP=82,1%). cfPMN% has moderate diagnostic potential.

Conclusions: cfIL-6 is increased after SAH in patients with VS or VC. Patients with a cfIL-6 over 3081 pg/ml have an increased post-test probability for VC; in patients with cfIL-6 levels between 529 and 3081 pg/ml both diagnoses have to be considered. In these cases N% and cfTLC are good markers for making the differential diagnosis.