Department of Neurosurgery, DaLian Medical University, DaLian, Liaoning, China.
Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
World Neurosurg. 2019 Jun;126:e1-e7. doi: 10.1016/j.wneu.2018.10.241. Epub 2018 Dec 11.
To evaluate values of cerebrospinal fluid (CSF) and serum procalcitonin (PCT) for diagnosis of intracranial infection after craniotomy and relationship between them and to explore value of PCT in guiding clinical use of antibiotics.
The incidence of intracranial infection in 21 patients undergoing craniotomy was reviewed. CSF samples and venous blood were collected for analysis. Diagnostic parameters were calculated via receiver operating characteristic curves, and inflammatory indicators were analyzed before and after administration of antibiotics in the infection group. As a control group, 32 patients without infection were recruited for the same measurements.
CSF and serum PCT levels in the infection group were higher than levels in the noninfection group (P < 0.05), and diagnostic efficiency of CSF PCT (area under the curve = 0.86, diagnostic odds ratio = 41.40) was superior to serum PCT (area under the curve = 0.66, diagnostic odds ratio = 3.40). Diagnostic efficiency was more powerful when serial testing was used (specificity = 0.99, positive likelihood ratio = 37.10, diagnostic odds ratio = 54.45). All inflammatory indicators decreased after administration of antibiotics except CSF protein (P = 0.129), and no obvious correlation was seen between CSF and serum PCT. Dynamic change of PCT can be used as a reference for adjusting antibiotics. CSF PCT can also be used as an indicator to identify intracranial infection with gram-negative bacteria.
CSF PCT is a good marker for intracranial infection and could be used to help confirm intracranial infection and provide guidance for clinical use of antibiotics when combined with serum PCT.
评估脑脊液（CSF）和血清降钙素原（PCT）对开颅术后颅内感染的诊断价值及其与两者之间的关系，并探讨 PCT 在指导临床抗生素应用中的价值。
回顾性分析 21 例行开颅术患者的颅内感染发生率，采集 CSF 样本和静脉血进行分析。通过受试者工作特征曲线计算诊断参数，并在感染组中分析抗生素治疗前后的炎症指标。以 32 例无感染的患者作为对照组进行相同的测量。
感染组 CSF 和血清 PCT 水平高于非感染组（P<0.05），CSF PCT（曲线下面积=0.86，诊断优势比=41.40）的诊断效率优于血清 PCT（曲线下面积=0.66，诊断优势比=3.40）。当进行连续检测时，诊断效率更高（特异性=0.99，阳性似然比=37.10，诊断优势比=54.45）。除 CSF 蛋白外（P=0.129），抗生素治疗后所有炎症指标均下降，CSF 和血清 PCT 之间未见明显相关性。PCT 的动态变化可作为调整抗生素的参考。CSF PCT 也可用作识别革兰氏阴性菌颅内感染的指标。
CSF PCT 是颅内感染的良好标志物，可与血清 PCT 联合使用，有助于确认颅内感染，并为临床抗生素应用提供指导。
