细胞指数在预测外置引流相关脑室-脑膜炎中的应用。
Utility of the Cell Index in Predicting External Ventricular Drain-Related Ventriculo-Meningitis.
机构信息
Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Department of Intensive Care Medicine, Royal Perth Hospital, Perth, WA, Australia.
出版信息
Neurocrit Care. 2020 Dec;33(3):776-784. doi: 10.1007/s12028-020-00964-w.
BACKGROUND/OBJECTIVE: Ventriculo-meningitis (VM) is an important complication of external ventricular drains (EVDs) in neurosurgical patients. Consequences include increased morbidity, mortality, and duration of hospital stay. Early diagnosis of EVD-associated VM allows earlier treatment intervention. The cell index (CI) may provide a simple measure that overcomes the limitations of isolated cerebrospinal fluid (CSF) parameters and other diagnostic tests, allowing earlier prediction of VM.
METHODS
All patients admitted to a tertiary hospital and requiring EVD insertion during 2015 and 2016 were assessed for inclusion in this retrospective case-control study. Patients with a known or suspected intracranial infection were excluded. Of the 186 patients who underwent EVD insertion, 95 patients were included in the final cohort. Data pertaining to patient characteristics and laboratory indices were extracted from health records and the microbiology laboratory database. The CI was calculated as the ratio of temporally related CSF leukocytes/erythrocytes to peripheral blood leukocytes/erythrocytes. Data from patients with microbiologically confirmed VM were analyzed in comparison with those not developing VM during the course of their stay. Categorical and continuous variables with skewed distributions were analyzed by Chi square and Mann-Whitney tests, respectively.
RESULTS
EVD-associated VM developed in 7.4% of patients. The highest CSF CI (within 3 days prior to diagnosis of VM or at any time for those not developing VM) differed significantly between the two groups (16; IQR 10.8-48.5 vs. 3.3; IQR 1.0-12.8, respectively; p = .046). The area under the receiver operating characteristic curve (AUROC) for the highest CI was 0.727 (95% confidence interval [CI] 0.526-0.929; p = .027). A CI of 10.4 provided a sensitivity and specificity of 80.5% and 70.5%, respectively, for the early diagnosis of VM.
CONCLUSIONS
In neurosurgical patients with an EVD, the CSF CI significantly predicted the development of VM.
背景/目的：脑室-脑膜炎（VM）是神经外科患者中外部脑室引流（EVD）的重要并发症。其后果包括发病率、死亡率和住院时间增加。早期诊断 EVD 相关 VM 可进行更早的治疗干预。细胞指数（CI）可能提供一种简单的衡量标准，克服了单独脑脊液（CSF）参数和其他诊断测试的局限性，允许更早地预测 VM。
方法
所有在 2015 年和 2016 年因需要 EVD 插入而入住三级医院的患者都被评估是否符合本回顾性病例对照研究的纳入标准。排除已知或疑似颅内感染的患者。在接受 EVD 插入的 186 名患者中，有 95 名患者被纳入最终队列。从健康记录和微生物学实验室数据库中提取与患者特征和实验室指标相关的数据。CI 计算为时间相关的 CSF 白细胞/红细胞与外周血白细胞/红细胞的比值。对微生物学确诊 VM 的患者数据进行分析，并与在住院期间未发生 VM 的患者数据进行比较。偏态分布的分类和连续变量分别通过卡方检验和曼-惠特尼检验进行分析。
结果
EVD 相关 VM 在 7.4%的患者中发生。在诊断 VM 之前的 3 天内（或对于未发生 VM 的患者）最高的 CSF CI 差异在两组之间有显著差异（16；IQR 10.8-48.5 与 3.3；IQR 1.0-12.8，分别；p=0.046）。最高 CI 的受试者工作特征曲线（AUROC）下面积为 0.727（95%置信区间 [CI] 0.526-0.929；p=0.027）。CI 为 10.4 时，对 VM 的早期诊断具有 80.5%的敏感性和 70.5%的特异性。
结论
在有 EVD 的神经外科患者中，CSF CI 显著预测了 VM 的发生。
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