Article
Predictive value of intrathecal Interleukin-6 for ventriculostomy-related infection
Vorhersagewert des intrathekalen Interleukin-6 für Meningitiden bei externer Liquorableitung
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Published: | April 11, 2007 |
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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).