Fuchinoue Yutaka, Kondo Kosuke, Sakaeyama Yuki, Nakada Chie, Terazono Sayaka, Kubota Syuhei, Mikai Masataka, Abe Mituyoshi, Ujiie Shinji, Morita Toshisuke, Sugo Nobuo
Department of Neurosurgery (Omori), Faculty of Medicine, Toho University, Tokyo, Japan.
Department of Laboratory Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
Front Neurol. 2024 Jul 18;15:1429354. doi: 10.3389/fneur.2024.1429354. eCollection 2024.
To determine the usefulness of cerebrospinal fluid (CSF) presepsin in the diagnosis of neurosurgical postoperative meningitis (POM).
The study included patients admitted to the Department of Neurosurgery, Toho University Medical Center Omori Hospital from May 1, 2020 to March 31, 2022 with suspected meningitis after neurosurgery who clinically required CSF sampling and patients who underwent CSF sampling for examination of idiopathic normal pressure hydrocephalus (iNPH). Participants were divided into a POM and a postoperative non meningitis (PONM) group based on the POM diagnostic criteria established for this study. The control group included patients from whom a CSF sample for iNPH was collected by tap test.
A total of 238 CSF samples were collected from 90 patients. There were 39 samples in the POM, 180 samples in the PONM, and 19 samples in the control group. CSF presepsin levels in the POM were significantly higher than in the PONM group (1764.5 and 440.9 pg./mL, respectively; < 0.0001). The control group had CSF presepsin levels of 95.5 pg./mL. A cutoff value of 669 pg./mL for CSF presepsin in POM and PONM groups had 76.9% sensitivity and 78.3% specificity for the diagnosis of POM. In analyzes including only subarachnoid hemorrhage (SAH) cases (123 samples), CSF presepsin (1251.2 pg./mL) in the POM was significantly higher than in the PONM subgroup (453.9 pg./mL; < 0.0001). The cutoff value for presepsin in CSF among patients with SAH (669 pg./mL) had 87.5% sensitivity and 76.6% specificity, similar to that of all patients.
CSF presepsin is a useful marker in the diagnosis of neurosurgical POM even in patients with blood components, such as SAH. When POM is suspected, measurement of CSF presepsin may be recommended in addition to a general CSF examination.
确定脑脊液（CSF）前降钙素在神经外科术后脑膜炎（POM）诊断中的作用。
该研究纳入了2020年5月1日至2022年3月31日入住东邦大学医学中心大森医院神经外科、术后疑似脑膜炎且临床需要进行脑脊液采样的患者，以及因特发性正常压力脑积水（iNPH）接受脑脊液采样检查的患者。根据本研究制定的POM诊断标准，将参与者分为POM组和术后非脑膜炎（PONM）组。对照组包括通过腰穿试验采集iNPH脑脊液样本的患者。
共从90例患者中采集了238份脑脊液样本。POM组有39份样本，PONM组有180份样本，对照组有19份样本。POM组的脑脊液前降钙素水平显著高于PONM组（分别为1764.5和440.9 pg/mL；P<0.0001）。对照组的脑脊液前降钙素水平为95.5 pg/mL。POM组和PONM组脑脊液前降钙素的截断值为669 pg/mL时，诊断POM的敏感性为76.9%，特异性为78.3%。在仅包括蛛网膜下腔出血（SAH）病例的分析（123份样本）中，POM组的脑脊液前降钙素（1251.2 pg/mL）显著高于PONM亚组（453.9 pg/mL；P<0.0001）。SAH患者脑脊液前降钙素的截断值（669 pg/mL）的敏感性为87.5%，特异性为76.6%，与所有患者相似。
即使对于有血液成分（如SAH）的患者，脑脊液前降钙素也是神经外科POM诊断中的有用标志物。当怀疑有POM时，除了常规的脑脊液检查外，可能建议检测脑脊液前降钙素。
