Article
Systemic inflammation markers like C-reactive protein and procalcitonin are not increased in ventriculostomy-related infections in patients with haemorrhagic stroke
Systemische Entzündungsmarker wie C-Reaktives Protein und Procalcitonin sind bei EVD-assoziierten Infekten in Patienten mit hämorrhagischen Schlaganfällen nicht erhöht
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Authors
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Sophie Shih-Yüng Wang
- Universitätsspital Zürich, Zürich, Switzerland
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Elisabeth Pietrzko
- Universitätsspital Zürich, Zürich, Switzerland
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Emanuela Keller
- Universitätsspital Zürich, Zürich, Switzerland
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Giovanna Brandi
- Universitätsspital Zürich, Zürich, Switzerland
| Published: | June 26, 2020 |
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Outline
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Objective: Ventriculostomy-related infection (VRI) is a serious complication in patients with hemorrhagic stroke. In such patients, early diagnosis of VRIs is complicated by blood contamination of CSF following ventricular hemorrhage. The role of serum-inflammatory markers in the diagnosis of VRIs is unclear. We therefore aim to evaluate the diagnostic potential of white blood cells count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) in patients who developed VRIs after hemorrhagic stroke with an external ventricular drain (EVD) in situ.
Methods: A total of 347 patients with hemorrhagic stroke (spontaneous subarachnoid, intra-parenchymal or intraventricular hemorrhage) with EVD were analysed in this cohort study. 14 patients developed a VRIs ("VRI"), defined by positive CSF bacterial culture and increased WBC in CSF (larger then range of 200-250 cells/mcgl), and 115 patients without VRIs ("no-VRI") with serial CSF sampling were included in the analysis. Patients with CSF-contamination or suspected VRI (negative CSF cultures but antibiotic treatments) were excluded. WBC, CRP, and PCT were measured daily. CSF was sampled routinely twice a week or by T>38°C. For the analysis, mean peak values of WBC, CRP, PCT during the time of EVD in situ were compared between groups (t test). Data are expressed as mean with CI 95%.
Results: Between both groups, WBC and CRP were similar (WBC: 15.13 G/L and 14.55 G/L, p=0.68 and CRP: 115.93 mg/l and 129.44 mg/l, p=0.56 in the group VRI and no-VRI, respectively) (Figure 1 [Fig. 1], panel A and B). In the group VRI, PCT was low and significantly lower than in the group no-VRI (0.16 ug/l and 2.61ug/l, p=0.03 in the group VRI and no-VRI, respectively) (panel C). WBC in CSF were similar between groups (710.14/ul and 675.16/ul p=0.93 in the group VRI and no-VRI, respectively).
Conclusion: We are able to show in our study population that serum PCR and PCT were not significantly different in patients with true VRIs (microbiologically confirmed) compared our control group ("no-VRI"). Therefore, the routine determination of those parameters for screening ventriculostomy-related infections caused by EVD in neurosurgical ICU patients with hemorrhagic stroke should be carefully evaluated.
