Inflammatory Markers in Serum and Cerebrospinal Fluid for Early Detection of External Ventricular Drain–associated Ventriculitis in Patients With Subarachnoid Hemorrhage

Lenski, Markus; Huge, Volker; Schmutzer, Michael; Ueberschaer, Moritz; Briegel, Josef; Tonn, Jörg‐Christian; Schichor, Christian; Thon, Niklas

doi:10.1097/ana.0000000000000496

Cited by 19 publications

(26 citation statements)

References 24 publications

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“…4,13,19,21 Nevertheless, based on the inclusion criteria of this study, our patients tended to have sustained more-severe TBI than patients in the STITCH[Trauma] trial; 19 the severity of TBI in our patients was similar to that of those in the BEST:TRIP trial. 4 Approximately 60% of patients with severe TBI need an EVD; 8 of these patients, between 1% and 30% 15,28,34 develop EVD-associated ventriculitis. EVD-associated ventriculitis contributes significantly to the high morbidity and poor outcome of ICU patients.…”

Section: Discussionmentioning

confidence: 99%

“…14 Therefore, it is essential to detect and treat ventriculitis at an early stage. 15 This may avoid ventriculitis-associated sequela, shorten hospital stay, and save costs for the healthcare system. Currently, CSF culture remains the gold standard for diagnosing bacterial meningitis and is positive in 70%-85% of cases prior to antibiotic administration.…”

Section: Discussionmentioning

confidence: 99%

“…14,17 Moreover, in the early phase after severe TBI, patients are severely ill and need antibiotic treatment for various indications (e.g., infections of the lung, urinary tract infections, sepsis), which may further reduce the diagnostic value of microbiological CSF samples. 15 In addition, it takes at least 48 hours for routine CSF cultures to yield results, limiting their clinical use acutely. 17 Here, we sought to identify the diagnostic potential of routine inflammatory markers in CSF and serum for early detection of ventriculitis after TBI and EVD implantation.…”

Section: Discussionmentioning

confidence: 99%

“…After the hair was shaved in the area of Kocher's point (2.5 cm from the midline and approximately 12 cm posterior to the nasion but anterior to the coronal suture), the skin was disinfected with a povidone-iodine solution. 15 The skin incision was made at Kocher's point, followed by a drill hole with a gimlet and catheter implantation into the lateral ventricle. A control scan confirmed correct positioning of the catheter and excluded a procedure-related hemorrhage.…”

Section: Methodsmentioning

confidence: 99%

“…detection of ventriculitis after SAH, 9 the diagnostic potential of inflammatory reactions in serum and CSF for the detection of ventriculitis after TBI has not yet been objectively assessed. Based on our experience with patients with SAH, 14,15 we aimed to investigate whether the interleukin-6 (IL-6) level in CSF in particular may be useful for the early detection of bacterial ventriculitis after TBI and placement of an EVD.…”

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Self Cite

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Hydrocephalus Related to CNS Malignancies in Adults

Rhun

Tonn

Weller

2019

Oncology of CNS Tumors

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Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study

Nielsen,

Olsen,

Willer-Hansen

et al. 2024

Acta Neurochir

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Background Ventriculostomy-associated infection (VAI) is common after external ventricular drains (EVD) insertion but is difficult to diagnose in patients with acute brain injury. Previously, we proposed a set of criteria for ruling out VAI in traumatic brain injury. This study aimed to validate these criteria. For exploratory purposes, we sought to develop and validate a score for VAI risk assessment in patients with different types of severe acute brain injury. Methods This retrospective cohort study included adults with acute brain injury who received an EVD and in whom CSF samples were taken over a period of 57 months. As standard non-coated bolt-connected EVDs were used. The predictive performance of biomarkers was analyzed as defined previously. A multivariable regression model was performed with five variables. Results A total of 683 patients with acute brain injury underwent EVD placement and had 1272 CSF samples; 92 (13.5%) patients were categorized as culture-positive VAI, 130 (19%) as culture-negative VAI, and 461 (67.5%) as no VAI. A low CSF WBC/RBC ratio (< 0.037), high CSF/plasma glucose ratio (> 0.6), and low CSF protein (< 0.5g/L) showed a positive predictive value of 0.09 (95%CI, 0.05–0.13). In the multivariable logistic regression model, days to sample (OR 1.09; 95%CI, 1.03–1.16) and CSF WBC/RBC ratio (OR 34.86; 95%CI, 3.94–683.15) were found to predict VAI. Conclusion In patients with acute brain injury and an EVD, our proposed combined cut-off for ruling out VAI performed satisfactorily. Days to sample and CSF WBC/RBC ratio were found independent predictors for VAI in the multivariable logistic regression model.

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Inflammatory Markers in Serum and Cerebrospinal Fluid for Early Detection of External Ventricular Drain–associated Ventriculitis in Patients With Subarachnoid Hemorrhage

Abstract: Routine determination of N% and CSFTLC are useful to distinguish ventriculitis from aseptic courses in the acute phase after aSAH and regardless of the bacteriological test result.

Cited by 19 publications

References 24 publications

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

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

Hydrocephalus Related to CNS Malignancies in Adults

Ventriculostomy-associated infection (VAI) in patients with acute brain injury—a retrospective study

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