gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Point-of-care assessment of inflammation in patients undergoing surgical evacuation of chronic subdural haematoma

Point-of-care Bestimmung von Entzündungsmarkern bei Patienten mit chronischem Subduralhämatom

Meeting Abstract

  • presenting/speaker Stepan Fedorko - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Johannes Walter - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Alexander Younsi - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Klaus Zweckberger - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Andreas Unterberg - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Christopher Beynon - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP220

doi: 10.3205/19dgnc555, urn:nbn:de:0183-19dgnc5558

Published: May 8, 2019

© 2019 Fedorko 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: Chronic inflammatory processes have been linked with the development of chronic subdural hematomas (cSDH) in patients, e.g. after minor haemorrhage following mild traumatic brain injury. It has been shown previously that elevated blood levels of presepsin, a truncated N-terminal fragment of CD14, indicate inflammation such as in sepsis but also inflammatory processes of non-bacterial origin. We hypothesized that point-of-care (POC) assessment of inflammatory markers in blood and the subdural fluid is feasible in patients undergoing surgical treatment of cSDH.

Methods: Presepsin was assessed with the Pathfast® Analyzer (Mitsubishi Medical Corp., Japan) in 18 patients treated at our institution for cSDH. Levels of C-reactive protein (CRP) and white blood cells (WBC) were routinely assessed prior to surgery in every patient. After burr hole trephination and hematoma evacuation, presepsin was assessed through examination of a whole blood sample and a sample of the subdural fluid collected intraoperatively in a heparinized syringe. Presepsin results were compared between samples of whole blood and the subdural compartment (student’s t-test).

Results: Presepsin levels were assessed within 11 minutes in all patients and no technical difficulties occurred. Compared to reported normal range values of presepsin (55–184 pg/mL), levels in samples of the subdural compartiment were drastically increased more than 4-fold (826±361 pg/mL). Furthermore, presepsin values in samples of the subdural compartiment were significantly higher than in samples from whole blood samples (166±73 pg/mL; p<0.001). The mean values of CRP and WBC were 26±26 mg/L and 8.4±1.8/L respectively.

Conclusion: POC assessment of inflammation markers within the subdural compartiment is feasible with the use of the Pathfast® analyzer. Our preliminary findings add to the growing body of evidence that inflammation plays a key role in the pathophysiology of cSDH. Further studies are necessary in order to characterize the role of presepsin in respective patients, e.g. with regard to the risk of haematoma recurrence. Theoretically, rapid POC assessment of inflammatory markers may provide valuable information during surgery in patients treated for cSDH.