Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy -
Department of Anesthesiology, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy -
Minerva Anestesiol. 2021 Jan;87(1):43-51. doi: 10.23736/S0375-9393.20.14222-6. Epub 2020 Nov 11.
The diagnosis of healthcare-associated ventriculitis and meningitis (HAVM) is challenging in the ICU setting. Traditional cerebrospinal fluid (CSF) markers and clinical signs of infection fail to diagnose HAVM in the critically ill setting. We sought to determine the diagnostic accuracy of measuring levels of high-mobility group box 1 (HMGB1) protein in cerebrospinal fluid (CSF) for the diagnosis of HAVM.
In this prospective observational cohort study, we enrolled 29 patients with an implanted external ventricular drainage (EVD). We tested the accuracy of CSF-HMGB1 as a diagnostic test for HAVM when compared to standard CSF parameters.
HAVM was diagnosed in 11/29 (37.9%) patients. These patients had significantly higher CSF-HMGB1 levels compared to patients without HAVM (median [IQR] 43.39 [83.51] ng/mL vs 6.46 ng/mL [10.94]; P<0.001). CSF-HMGB1 and CSF-glucose were independently related to HAVM, with OR's (95% CI) of 15.43 (15.37 to 15.48, P<0.0001) and 0.31 (0.30 to 0.32, P<0.0001), respectively. The AUC [CI] of CSF-HMGB1 to predict HAVM was 0.83 [0.72 to 0.94].
HMGB1 is an accurate marker of HAVM and it adds incremental diagnostic value when paired with CSF-glucose measurements. Future larger and multicenter studies should assess the incremental diagnostic value of HMGB1 data when used alongside other established CSF markers of infection, and the external validity of these preliminary results.
在重症监护病房（ICU）环境中，医疗相关性脑室炎和脑膜炎（HAVM）的诊断具有挑战性。传统的脑脊液（CSF）标志物和感染的临床体征未能在危重病患者中诊断出 HAVM。我们旨在确定测量脑脊液（CSF）中高迁移率族蛋白 1（HMGB1）蛋白水平对 HAVM 诊断的准确性。
在这项前瞻性观察性队列研究中，我们纳入了 29 名患有植入式外部脑室引流（EVD）的患者。我们将 CSF-HMGB1 与标准 CSF 参数进行比较，以测试其作为 HAVM 诊断测试的准确性。
在 29 名患者中，诊断出 HAVM 11 例（37.9%）。与无 HAVM 患者相比，这些患者的 CSF-HMGB1 水平显著更高（中位数[四分位距] 43.39 [83.51] ng/mL 比 6.46 ng/mL [10.94]；P<0.001）。CSF-HMGB1 和 CSF 葡萄糖与 HAVM 独立相关，比值比（95%CI）分别为 15.43（15.37 至 15.48，P<0.0001）和 0.31（0.30 至 0.32，P<0.0001）。CSF-HMGB1 预测 HAVM 的 AUC [CI]为 0.83 [0.72 至 0.94]。
HMGB1 是 HAVM 的准确标志物，与 CSF 葡萄糖测量值相结合时具有额外的诊断价值。未来更大规模的多中心研究应评估 HMGB1 数据与其他已建立的 CSF 感染标志物联合使用时的额外诊断价值，以及这些初步结果的外部有效性。
