Artikel
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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Autoren
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Markus Lenski
- Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany
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Volker Huge
- Klinik für Anästhesiologie, Klinikum Großhadern, LMU München, Germany
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Josef Briegel
- Klinik für Anästhesiologie, Klinikum Großhadern, LMU München, Germany
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Jörg-Christian Tonn
- Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany
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Christian Schichor
- Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany
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Niklas Thon
- Klinik für Neurochirurgie, Klinikum Großhadern, LMU München, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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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.
