Plasma Inflammatory Markers and Ventriculostomy-Related Infection in Patients With Hemorrhagic Stroke: A Retrospective and Descriptive Study

Abstract

BackgroundDiagnosis of ventriculostomy-related infection (VRI) remains difficult due to the various existing definitions. In patients with hemorrhagic stroke, its diagnosis might be further complicated by the presence of intraventricular blood. Furthermore, hemorrhagic stroke per se may cause symptoms compatible with VRI. This study aimed to evaluate the benefit of plasma inflammatory markers for the diagnosis of VRI and its differentiation from patients with non-cerebral infection and patients without infection in a cohort of patients with hemorrhagic stroke.MethodsA total of 329 patients with hemorrhagic stroke and an external ventricular drain (EVD) in situ were admitted to the Neurocritical Care Unit, University Hospital Zurich over a period of 6 years. Of those patients, 187 with subarachnoid hemorrhage and 76 with spontaneous intracerebral hemorrhage were included. Patients with VRI were compared to patients without any infection and to patients with non-cerebral infection, with regards to their clinical characteristics, as well as their inflammatory plasma and cerebrospinal fluid (CSF) markers. For the analysis, peak values were considered.ResultsThe VRI was diagnosed in 36% of patients with subarachnoid and in 17% of patients with intracerebral hemorrhage. The VRI was diagnosed on an average day 9±6.2 after EVD insertion, one day after the white blood cell count (WBC) peaked in CSF (8 ± 6.3). Plasma inflammatory markers (WBC, C-reactive protein “CRP” and procalcitonin “PCT”) did not differ among patients with VRI compared to patients without infection. The CRP and PCT, however, were higher in patients with non-cerebral infection than in patients with VRI. The WBC in CSF was generally higher in patients with VRI compared to both patients without any infection and patients with non-cerebral infection.ConclusionsNo differences in plasma inflammatory markers could be found between patients with VRI and patients without any infection. Conversely, CRP/PCT were higher in patients with non-cerebral infection than in patients with VRI. Altogether, CRP, PCT, and WBC are not suitable parameters for VRI diagnosis in neurocritical care unit patients.

Broad Range Eubacterial Polymerase Chain Reaction of Cerebrospinal Fluid Reduces the Time to Exclusion of and Costs Associated with Ventriculostomy-Related Infection in Hemorrhagic Stroke

“…Similarly, the IDSA recommends that new headache, nausea, lethargy, and or change in mental status, as well as fever, in the absence of another clear source of infection, could be suggestive of VRI [ 8 ]. WBC in CSF > 500/µl (set as a local cutoff both based on the local experience and previous research [ 23 ]). Because of the frequent occurrence of intraventricular blood, the IDSA considers CSF cell count potentially not be a reliable indicator for the presence of infection in patients with VRI [ 8 ].…”

“…WBC in CSF > 500/µl (set as a local cutoff both based on the local experience and previous research [ 23 ]). Because of the frequent occurrence of intraventricular blood, the IDSA considers CSF cell count potentially not be a reliable indicator for the presence of infection in patients with VRI [ 8 ].…”

“…Data from this prospective cohort were compared with a previously described retrospective cohort with suspected VRI treated at our NCCU between 2013 and 2019 before the introduction of CSF ePCR testing [ 23 ]. Diagnostic criteria for VRI for the retrospective cohort are available in the supplementary materials (list, Suppl.…”

Factors influencing procalcitonin in the cerebrospinal fluid of patients after neurosurgery and its diagnostic value for intracranial infection

“…Our previous study also suggested that when the PCT in the CSF surpass serum PCT, it can serve as a diagnostic indicator for intracranial infections [ 9 ]. However, other studies have shown that the increase in CSF PCT is nonspecific since it is influenced by serum PCT when the blood–brain barrier (BBB) is compromised after neurosurgery [ 10 – 12 ]. Multiple organ dysfunction syndrome, pancreatitis, paraquat poisoning, among other noninfectious conditions, have been shown to elevate serum PCT levels [ 13 , 14 ].…”

Procalcitonin As Diagnostic Tool for CNS Infections—Overall, Not Good Enough (Yet?)*

“…Nevertheless, the performance of neither CSF nor serum procalcitonin for post-neurosurgical meningitis reaches that of community-acquired meningitis in children. In fact, while not included in the review by Biasucci et al (2), a study that retrospectively assessed inflammatory markers for ventriculostomy-related infections vs. no infection (14), found no discriminatory reliability for procalcitonin. Although those authors evaluated only serum procalcitonin and used a nonstandard definition of ventriculostomy-related infection (14), the question of why procalcitonin performs worse for post-neurosurgical infections remains unanswered.…”