Department of Intensive Care Unit, the Affiliated People's Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, Zhejiang Province, People's Republic of China.
BMC Neurol. 2023 Aug 1;23(1):288. doi: 10.1186/s12883-023-03339-8.
This study aimed to investigate the factors influencing Procalcitonin (PCT) in the cerebrospinal fluid (CSF) of patients with high fever and suspected intracranial infection after neurosurgery and its clinical application value.
Between February 2021 and August 2022, CSF and serum samples were collected via lumbar puncture from patients with high fever and suspected intracranial infection in the Intensive Care Unit(ICU) of our hospital. Multivariate logistic regression analysis was performed to analyze the factors influencing elevated PCT in CSF. The diagnostic efficacy of each index was assessed using receiver operating characteristic (ROC) curves.
A total of 183 CSF samples were collected, of which 148 had increased PCT levels, including 73 cases of intracranial infection and 75 cases in the case‒control group. Multivariate logistic regression analysis showed that intracranial infection [OR = 0.117, 95% CI: 0.025-0.559; p < 0.01] and hemorrhagic CSF [OR = 0.162, 95% CI: 0.029-0.916; p < 0.04] were factors influencing CSF PCT, while trauma [OR = 3.43, 95% CI: 0.76-15.45; p < 0.12], epileptic seizure [OR = 0.00, 95% CI: 0.00; p < 0], age [OR = 1.02, 95% CI: 0.98-1.52; p < 0.32] and Glasgow Coma Scale (GCS) score [OR = 1.03, 95% CI: 0.78-1.32; p < 0.83] did not influence CSF PCT. The CSF PCT and serum PCT levels in the intracranial infection group and the case‒control group were 0.13 (0.11, 0.25) ng/ml and 0.14 (0.07, 0.25) ng/ml and 0.14 (0.08,0.32) ng/ml and 0.23 (0.13,0.48)ng/ml, respectively, with no statistically significant difference. The median values of CSF lactate in the intracranial infection group and the case‒control group were 6.45 (4.475, 8.325) mmol/l and 3.2 (2.02, 4.200) mmol/l, respectively, with a statistically significant difference between the groups.The areas under the ROC curve of CSF PCT, serum PCT,CSF lactate, CSF PCT combined with lactate were 0.59, 0.63, 0.82,and 0.83,respectively.
Intracranial infection and hemorrhagic CSF are influencing factors for elevated CSF PCT following neurosurgery. It should be noted that the diagnostic value of intracranial infection by CSF PCT elevated alone is limited, but the combination it with other indicators can help improve diagnostic efficacy.
本研究旨在探讨神经外科术后高热并疑似颅内感染患者脑脊液（CSF）中降钙素原（PCT）升高的影响因素及其临床应用价值。
2021 年 2 月至 2022 年 8 月，我院 ICU 对高热并疑似颅内感染患者进行腰椎穿刺，采集 CSF 和血清样本。采用多因素 logistic 回归分析影响 CSF 中 PCT 升高的因素。采用受试者工作特征（ROC）曲线评估各指标的诊断效能。
共采集 183 份 CSF 样本，其中 148 份 CSF PCT 水平升高，包括颅内感染 73 例，病例对照 75 例。多因素 logistic 回归分析显示，颅内感染[OR=0.117，95%CI：0.025-0.559；p<0.01]和出血性 CSF[OR=0.162，95%CI：0.029-0.916；p<0.04]是影响 CSF PCT 的因素，而创伤[OR=3.43，95%CI：0.76-15.45；p<0.12]、癫痫发作[OR=0.00，95%CI：0.00；p<0.001]、年龄[OR=1.02，95%CI：0.98-1.52；p<0.32]和格拉斯哥昏迷量表（GCS）评分[OR=1.03，95%CI：0.78-1.32；p<0.83]不影响 CSF PCT。颅内感染组和病例对照组 CSF PCT 和血清 PCT 水平分别为 0.13（0.11，0.25）ng/ml 和 0.14（0.07，0.25）ng/ml，0.14（0.08，0.32）ng/ml 和 0.23（0.13，0.48）ng/ml，差异无统计学意义。颅内感染组和病例对照组 CSF 乳酸中位数分别为 6.45（4.475，8.325）mmol/L 和 3.2（2.02，4.200）mmol/L，组间差异有统计学意义。CSF PCT、血清 PCT、CSF 乳酸、CSF PCT 联合乳酸的 ROC 曲线下面积分别为 0.59、0.63、0.82 和 0.83。
颅内感染和出血性 CSF 是神经外科术后 CSF PCT 升高的影响因素。值得注意的是，单独 CSF PCT 升高对颅内感染的诊断价值有限，但与其他指标联合使用有助于提高诊断效能。
