Cell Index in the Diagnosis of External Ventricular Drain-Related Infections

Lunardi, Luciano Werle; Zimmer, Eduardo R.; Santos, Samir Cezimbra dos; Merzoni, Jóice; Portela, Luis Valmor; Stefani, Marco Antônio

doi:10.1016/j.wneu.2017.07.012

Cited by 14 publications

(12 citation statements)

References 10 publications

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“…15 While many biomarker studies did not include patients with TBI, 10,14,15,23 our literature search identified 3 main studies that included subpopulations of patients with TBI and examined CSF inflammatory markers for diagnosing ventriculitis. 17,18,34 In our study, TLC in CSF was significantly increased in patients with ventriculitis and had a very good diagnostic potential for predicting EVD-associated ventriculitis (cutoff value 64.5/µL). This finding is in line with those of previous reports.…”

Section: Discussionsupporting

confidence: 53%

“…17,34 Another recently published study showed that the cell index (ratio of leukocytes to erythrocytes in CSF and leukocytes to erythrocytes in the peripheral blood) had a good diagnostic potential for predicting ventriculitis. 18,23 Since the TLC in CSF already showed good diagnostic potential for diagnosing ventriculitis in this and other studies of TBI patients, it remains unclear whether the determination of the cell index could provide further diagnostic information.…”

Section: Discussionmentioning

confidence: 89%

“…Other studies have been limited by a heterogeneous study population of patients who experienced numerous types of brain injury (e.g., SAH, intracranial bleeding, intraventricular bleeding, craniotomy, EVD only). 7,17,18,23,28,34 Limitations include that our study was designed as a retrospective clinical study. Therefore, data acquisition may not have been as accurate as that in prospective clinical studies.…”

Section: Discussionmentioning

confidence: 99%

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Significance of cerebrospinal fluid inflammatory markers for diagnosing external ventricular drain–associated ventriculitis in patients with severe traumatic brain injury

Lenski

Biczok

Neufischer

et al. 2019

Neurosurgical Focus

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ObjectiveThe aim of this study was to investigate the diagnostic potential of the inflammatory markers interleukin-6 (IL-6), total leukocyte count (TLC), and protein in the CSF and IL-6, C-reactive protein, and white blood cell count in the serum for the early diagnosis of ventriculitis in patients with traumatic brain injury (TBI) and an external ventricular drain compared with patients without ventriculitis.MethodsRetrospective data from 40 consecutive patients with TBI and an external ventricular drain treated in the authors’ intensive care unit between 2013 and 2017 were analyzed. For all markers, arithmetical means and standard deviations, area under the curve (AUC), cutoff values, sensitivity, specificity, positive likelihood ratio (LR), and negative LR were calculated and correlated with presence or absence of ventriculitis.ResultsThere were 35 patients without ventriculitis and 5 patients with ventriculitis. The mean ± SD IL-6 concentration in CSF was significantly increased, with 6519 ± 4268 pg/mL at onset of ventriculitis compared with 1065 ± 1705 pg/mL in patients without ventriculitis (p = 0.04). Regarding inflammatory markers in CSF, IL-6 showed the highest diagnostic potential for differentiation between the presence and absence of ventriculitis (AUC 0.938, cutoff 4064 pg/mL, sensitivity 100%, specificity 92.3%, positive LR 13, and negative LR 0), followed by TLC (AUC 0.900, cutoff 64.5 /µL, sensitivity 100%, specificity 80%, positive LR 5.0, and negative LR 0) and protein (AUC 0.876, cutoff 31.5 mg/dL, sensitivity 100%, specificity 62.5%, positive LR 2.7, and negative LR 0).ConclusionsThe level of IL-6 in CSF has the highest diagnostic value of all investigated inflammatory markers for detecting ventriculitis in TBI patients at an early stage. In particular, CSF IL-6 levels higher than the threshold of 4064 pg/mL were significantly associated with the probability of ventriculitis.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Significance of cerebrospinal fluid inflammatory markers for diagnosing external ventricular drain–associated ventriculitis in patients with severe traumatic brain injury

Lenski

Biczok

Neufischer

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

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“…The cell index is calculated as the ratios of white blood cell count and red blood cell count in the CSF and the blood. Lunardi's study showed, that a cut-off point of 2.9 was indicative for infection, as was a 4.33-fold increase of the cell index over time [86].…”

Section: Neurostimulator-associated Infections (Deep Brain and Spinal Cord Stimulators)mentioning

confidence: 99%

“…As there is a lack of more sensitive and specific criteria, EVD-associated infection is mostly diagnosed on the basis of CSF pleocytosis and the presence of fever, resulting in a significantly higher rate of postulated than microbiologically proven infections, which is considered the gold standard [83]. Some studies found an increased cell index and CSF lactate (at a cut-off of 4 mmol/ l) to be predictive for EVD-associated infections [84][85][86][87].…”

Section: Neurostimulator-associated Infections (Deep Brain and Spinal Cord Stimulators)mentioning

confidence: 99%

Management of neurosurgical implant-associated infections

et al. 2020

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With the technical developments in neurosurgery, increasing numbers of neurosurgical implants are used in an increasingly aged population of patients with several comorbidities. Consequently, the number of neurosurgical implant-associated infections is continuously raising, resulting in significant morbidity and mortality, including disfiguring skull deformities and lack of brain protection. In this article we review infections associated with craniotomy, cranioplasty, neurostimulators, internal cerebrospinal fluid shunts, and external ventricular and lumbar cerebrospinal fluid drainages.

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