Koopman Inez, Zuithoff Nicolaas P A, Rinkel Gabriel J E, Vergouwen Mervyn D I
Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
J Neurol Sci. 2020 Aug 15;415:116899. doi: 10.1016/j.jns.2020.116899. Epub 2020 May 19.
Aneurysmal subarachnoid hemorrhage (aSAH) patients have an inflammatory response in the cerebrospinal fluid (CSF). We determined CSF cell counts, erythrocyte/leukocyte ratio, and glucose- and protein concentrations in patients ≤20 days after aSAH without bacterial meningitis. Such knowledge may help to interpret CSF parameters in patients with an external drain if nosocomial bacterial meningitis or ventriculitis is suspected.
Patients with aSAH admitted between 2010 and 2017 with at least one CSF sample ≤ 20 days after ictus were included from a prospectively collected database. CSF samples were excluded if the patient used antibiotics or if the CSF culture was positive. We calculated estimated marginal means with 95% confidence intervals (CIs) with linear mixed models for CSF cell counts, glucose- and protein concentrations.
We included 209 patients with 306 CSF samples. Highest estimated median leukocyte count was 305 (95%CI:225-412) x10^6/L, and the lowest estimated median erythrocyte/leukocyte ratio was 109 (95%CI:73-163). Estimated mean glucose concentrations remained within the normal range. The estimated median protein concentration decreased from 3.3 g/L (95%CI:2.5-4.2) on day 0 to 1.0 g/L (95%CI:0.8-1.2) on day 14.
The limits we found for the inflammatory reaction in aSAH patients may help physicians to interpret CSF parameters in aSAH patients with an external CSF drain. Future studies are needed to compare CSF parameters in aSAH patients with and without bacterial meningitis or ventriculitis.
动脉瘤性蛛网膜下腔出血（aSAH）患者的脑脊液（CSF）存在炎症反应。我们测定了无细菌性脑膜炎的aSAH患者发病后≤20天的脑脊液细胞计数、红细胞/白细胞比值以及葡萄糖和蛋白质浓度。如果怀疑有医院获得性细菌性脑膜炎或脑室炎，这些知识可能有助于解释使用外部引流管患者的脑脊液参数。
从一个前瞻性收集的数据库中纳入2010年至2017年期间入院的aSAH患者，这些患者在发病后至少有一份脑脊液样本≤20天。如果患者使用了抗生素或脑脊液培养呈阳性，则排除脑脊液样本。我们使用线性混合模型计算脑脊液细胞计数、葡萄糖和蛋白质浓度的估计边际均值及其95%置信区间（CI）。
我们纳入了209例患者的306份脑脊液样本。估计的最高白细胞计数中位数为305（95%CI：225 - 412）×10^6/L，最低红细胞/白细胞比值估计中位数为109（95%CI：73 - 163）。估计的平均葡萄糖浓度保持在正常范围内。估计的蛋白质浓度中位数从第0天的3.3 g/L（95%CI：2.5 - 4.2）降至第14天的1.0 g/L（95%CI：0.8 - 1.2）。
我们发现的aSAH患者炎症反应的界限可能有助于医生解释有外部脑脊液引流管的aSAH患者的脑脊液参数。未来需要进行研究，比较有无细菌性脑膜炎或脑室炎的aSAH患者的脑脊液参数。
