Lunardi Luciano Werle, Zimmer Eduardo R, Dos Santos Samir C, Merzoni Jóice, Portela Luis V, Stefani Marco Antonio
Serviço de Controle de Infecção, Hospital Cristo Redentor, Porto Alegre, RS, Brazil.
Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Brain Institute (BraIns) of Rio Grande do Sul, Porto Alegre, Brazil.
World Neurosurg. 2017 Oct;106:504-508. doi: 10.1016/j.wneu.2017.07.012. Epub 2017 Jul 12.
The use of an external ventricular drain is required for the treatment of many diseases, such as traumatic brain injury and subarachnoid hemorrhage (SAH). Meningitis and ventriculitis are frequent complications arising from the use of external ventricular drain therapy. This study aimed to determine the sensitivity, specificity, and cutoff point for cell index (CI) in patients with traumatic brain injury, SAH, and hemorrhagic stroke.
Our study population consisted of patients with different underlying diseases and few culture-positive cerebrospinal fluid samples. The diagnosis of infection was based on Centers of Disease Control and Prevention criteria.
Overall CI analysis showed an area under the curve (AUC) of 0.982. The cutoff of 2.9 for overall CI provided a sensitivity of 95% and a specificity of 92.9%. In patients with SAH, the AUC was 1.0 for a CI of 2.8; furthermore, sensitivity and specificity were 100%. The relative variation of the CI was also assessed. This analysis revealed an AUC of 0.882, and a 4.33-fold increase was found be indicative of infection (P = 0.002), findings similar to those in the literature. In addition, a heatmap analysis demonstrated that the CI is unlikely to return to normal in patients with meningitis, even after treatment.
Therefore, CI is valuable for the diagnosis of infection, but was inadequate for monitoring treatment. We hope to use the new cutoff point proposed by this study in our institution to improve patient clinical outcome.
许多疾病的治疗需要使用外部脑室引流，如创伤性脑损伤和蛛网膜下腔出血（SAH）。脑膜炎和脑室炎是外部脑室引流治疗常见的并发症。本研究旨在确定创伤性脑损伤、SAH和出血性中风患者细胞指数（CI）的敏感性、特异性和临界值。
我们的研究人群包括患有不同基础疾病且脑脊液培养阳性样本较少的患者。感染的诊断基于疾病控制与预防中心的标准。
总体CI分析显示曲线下面积（AUC）为0.982。总体CI的临界值为2.9时，敏感性为95%，特异性为92.9%。在SAH患者中，CI为2.8时AUC为1.0；此外，敏感性和特异性均为100%。还评估了CI的相对变化。该分析显示AUC为0.882，发现增加4.33倍表明存在感染（P = 0.002），这一结果与文献报道相似。此外，热图分析表明，脑膜炎患者即使经过治疗，CI也不太可能恢复正常。
因此，CI对感染诊断有价值，但对治疗监测不足。我们希望在我们的机构中使用本研究提出的新临界值来改善患者的临床结局。
