Higher Procalcitonin Level in Cerebrospinal Fluid than in Serum Is a Feasible Indicator for Diagnosis of Intracranial Infection

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

OBJECTIVE

This study aimed to investigate the factors influencing Procalcitonin (PCT) in the cerebrospinal fluid (CSF) of patients with high fever and suspected intracranial infection after neurosurgery and its clinical application value.

METHODS

Between February 2021 and August 2022, CSF and serum samples were collected via lumbar puncture from patients with high fever and suspected intracranial infection in the Intensive Care Unit(ICU) of our hospital. Multivariate logistic regression analysis was performed to analyze the factors influencing elevated PCT in CSF. The diagnostic efficacy of each index was assessed using receiver operating characteristic (ROC) curves.

RESULTS

A total of 183 CSF samples were collected, of which 148 had increased PCT levels, including 73 cases of intracranial infection and 75 cases in the case‒control group. Multivariate logistic regression analysis showed that intracranial infection [OR = 0.117, 95% CI: 0.025-0.559; p < 0.01] and hemorrhagic CSF [OR = 0.162, 95% CI: 0.029-0.916; p < 0.04] were factors influencing CSF PCT, while trauma [OR = 3.43, 95% CI: 0.76-15.45; p < 0.12], epileptic seizure [OR = 0.00, 95% CI: 0.00; p < 0], age [OR = 1.02, 95% CI: 0.98-1.52; p < 0.32] and Glasgow Coma Scale (GCS) score [OR = 1.03, 95% CI: 0.78-1.32; p < 0.83] did not influence CSF PCT. The CSF PCT and serum PCT levels in the intracranial infection group and the case‒control group were 0.13 (0.11, 0.25) ng/ml and 0.14 (0.07, 0.25) ng/ml and 0.14 (0.08,0.32) ng/ml and 0.23 (0.13,0.48)ng/ml, respectively, with no statistically significant difference. The median values of CSF lactate in the intracranial infection group and the case‒control group were 6.45 (4.475, 8.325) mmol/l and 3.2 (2.02, 4.200) mmol/l, respectively, with a statistically significant difference between the groups.The areas under the ROC curve of CSF PCT, serum PCT,CSF lactate, CSF PCT combined with lactate were 0.59, 0.63, 0.82,and 0.83,respectively.

CONCLUSION

Intracranial infection and hemorrhagic CSF are influencing factors for elevated CSF PCT following neurosurgery. It should be noted that the diagnostic value of intracranial infection by CSF PCT elevated alone is limited, but the combination it with other indicators can help improve diagnostic efficacy.

Heparin-binding protein as a marker of ventriculostomy related infection and central nervous system inflammation in neuro-intensive care

OBJECTIVE

Diagnosis of ventriculostomy related infections (VRI) in the neuro-intensive care unit remains challenging and current biomarkers lack adequate precision. The aim of this study was to explore the potential of Heparin-binding protein (HBP) in cerebrospinal fluid (CSF) as a diagnostic biomarker of VRI.

METHODS

All patients treated with an external ventricular drain (EVD) between January 2009 and March 2010 at Skåne university hospital in Lund, Sweden, were consecutively included. CSF samples obtained during routine care were analyzed for HBP. VRI was defined as a positive bacterial microbiology test result on a CSF sample with an erythrocyte-corrected leukocyte count of > 50 × 106/l. HBP levels at VRI diagnosis was compared to peak HBP levels in non-VRI controls.

RESULTS

In total, 394 CSF samples from 103 patients were analyzed for HBP. Seven patients (6.8%) fulfilled VRI criteria. Levels of HBP were significantly higher in VRI subjects (31.7 ng/mL [IQR 26.9-40.7 ng/mL]) compared to non-VRI controls (7.7 ng/mL [IQR 4.1-24.5 ng/mL]) (p = 0.024). The AUC of the receiver operating characteristic (ROC) curve was 0.76 (95% confidence interval [CI], 0.62-0.90). Among non-VRI patients, HBP was highest in patients with acute bacterial meningitis. Patients with subarachnoid hemorrhage displayed higher HBP levels than those with traumatic brain injury or shunt dysfunction.

CONCLUSIONS

HBP levels were higher in VRI subjects and varied between patients and different diagnoses. To validate the clinical usefulness and added value of HBP as a biomarker for VRI, the results need to be confirmed in larger studies with head-to-head comparisons to current biomarkers.

A data-driven medical knowledge discovery framework to predict the length of ICU stay for patients undergoing craniotomy based on electronic medical records

Craniotomy is an invasive operation with great trauma and many complications, and patients undergoing craniotomy should enter the ICU for monitoring and treatment. Based on electronic medical records (EMR), the discovery of high-risk multi-biomarkers rather than a single biomarker that may affect the length of ICU stay (LoICUS) can provide better decision-making or intervention suggestions for clinicians in ICU to reduce the high medical expenses of these patients and the medical burden as much as possible. The multi-biomarkers or medical decision rules can be discovered according to some interpretable predictive models, such as tree-based methods. Our study aimed to develop an interpretable framework based on real-world EMRs to predict the LoICUS and discover some high-risk medical rules of patients undergoing craniotomy. The EMR datasets of patients undergoing craniotomy in ICU were separated into preoperative and postoperative features. The paper proposes a framework called Rules-TabNet (RTN) based on the datasets. RTN is a rule-based classification model. High-risk medical rules can be discovered from RTN, and a risk analysis process is implemented to validate the rules discovered by RTN. The performance of the postoperative model was considerably better than that of the preoperative model. The postoperative RTN model had a better performance compared with the baseline model and achieved an accuracy of 0.76 and an AUC of 0.85 for the task. Twenty-four key decision rules that may have impact on the LoICUS of patients undergoing craniotomy are discovered and validated by our framework. The proposed postoperative RTN model in our framework can precisely predict whether the patients undergoing craniotomy are hospitalized for too long (more than 15 days) in the ICU. We also discovered and validated some key medical decision rules from our framework.

Correlation between surgical site infection and time-dependent blood platelet count in immunocompromised patients after femoral neck fracture

Objective

The incidence of surgical site infection (SSI) after femoral neck fracture is significantly higher in immunocompromised patients. This study was performed to explore the temporal changes of blood-related parameters in immunocompromised patients after femoral neck fracture repair and to determine the correlation between the platelet (PLT) count and SSI.

Methods

This study involved 101 immunocompromised patients who underwent repair of a femoral neck fracture from April 2018 to August 2019. SSI was confirmed by postoperative observation of the incision and B-mode ultrasound imaging examination. Blood parameter measurements and dynamic observation were performed 1, 3, 5, 7, and 14 days postoperatively.

Results

The procalcitonin concentration, D-dimer concentration, and PLT count were strongly correlated with temporal changes. The PLT count changes crossed between patients with and without SSI 3 to 5 days after surgery, and the PLT count increased in patients with SSI 3 to 5 days after surgery. The PLT count had high specificity and sensitivity for predicting SSI with a cut-off value of 167.5 × 109/L.

Conclusion

The temporal changes of the PLT count in immunocompromised patients who have undergone femoral neck fracture repair can serve as an early warning of SSI.

The risk factors of intracranial infection in patients with intracerebral hemorrhage undergone hematoma puncture: what should we care

BACKGROUND

Intracranial infection after puncture of cerebral hematoma in patients with intracerebral hemorrhage is very common in the department of neurosurgery, yet the relevant risks remain unknown. We attempted to analyze the risk factors of intracranial infection after puncture of cerebral hematoma, to provide insights into the management of patients with intracerebral hemorrhage after puncture of cerebral hematoma.

METHODS

Patients with intracerebral hemorrhage after puncture of cerebral hematoma treated in our hospital from January 2017 to January 2020 were selected, the related characteristics of intracranial infection and no infection patients were compared. Logistic regression analyses were conducted to analyze the risk factors for intracranial infection after puncture of cerebral hematoma.

RESULTS

A total of 925 patients with puncture of cerebral hematoma were included. The incidence of postoperative intracranial infection was 7.03%. There were significant statistical differences between the infected group and the no infection group in the American Association of Anesthesiologists (ASA) grade, length of hospital stay, consecutive operation, duration of surgery, extra-ventricular drainage (EVD) use (all p < 0.05). There was statistically significant difference in the duration of EVD between the infection and no infection groups (p = 0.002), and there was no significant difference in the frequency of EVD insertion between the two groups (p = 0.094). The length of hospital stay≥10 days (OR1.832, 1.062-3.158), consecutive operation (OR2.158, 1.358-3.430), duration of surgery≥4 h (OR1.581, 1.031-2.425), EVD use (OR1.694, 1.074-2.670), and duration of EVD ≥ 7 days (OR2.699, 1.689-4.311) were the risk factors of intracranial infection in patients with intracerebral hemorrhage after puncture of cerebral hematoma (all p < 0.05).

CONCLUSION

Clinical medical workers should take corresponding preventive measures against the different risk factors for prevention of intracranial infection in patient with puncture of cerebral hematoma.

Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery

BACKGROUND

Intracranial infection is a common clinical disease. Computed tomography (CT) and magnetic resonance imaging (MRI) have certain sensitivity and have good diagnostic efficacy.

AIM

To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.

METHODS

We selected 82 patients who underwent craniocerebral surgery (including 40 patients with intracranial infection and 42 patients without infection) during the period from April 2016 to June 2019 in our hospital. All 82 patients received CT and MRI examinations, and their clinical data were reviewed. A retrospective analysis was performed, and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods. The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.

RESULTS

For all types of pathogenic infections (Staphylococcus aureus, Staphylococcus hemolyticus, Staphylococcus epidermidis, and others), MRI scans had higher positive diagnostic coincidence rates than CT scans; the overall diagnostic coincidence rate, sensitivity, specificity, positive predictive value, and negative predictive values were significantly higher with MRI examinations than with CT examinations, and the differences were statistically significant (P < 0.05).

CONCLUSION

MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery. Compared with CT, MRI had higher diagnostic efficiency. The diagnostic sensitivity and specificity, the diagnostic coincidence rate, and the positive and negative predictive values were significantly higher with MRI than with conventional CT, which can be actively promoted.