Kong Yueyue, Niu Jiahao, Liu Zhiming, Zhou Wentao, Tian Yongji, Shi Guangzhi
Department of Critical Care Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing , China.
Neurosurgical Centre, Beijing Tiantan Hospital, Capital Medical University, Beijing , China.
Neurosurgery. 2025 Jun 13;97(3):710-718. doi: 10.1227/neu.0000000000003505.
Early and accurate diagnosis of meningitis and ventriculitis after craniotomy is still quite challenging. The research aimed to examine if cerebrospinal fluid (CSF) heparin-binding protein (HBP) can enhance the accuracy in diagnosing healthcare-associated meningitis or ventriculitis in children compared with lactate and procalcitonin (PCT).
Children with craniotomy for ventricular system tumors were eligible for this prospective observational cohort study. Heparin-binding protein, PCT, white blood cell count, glucose, protein, and lactate in CSF were tested when children were suspected of developing CSF infections, as were Gram staining and cultures.
Among 122 eligible participants, 116 with 279 samples were enrolled in the final analysis, including 71 children (142 samples) with healthcare-associated meningitis or ventriculitis as the infected group and 45 children (137 samples) with no CSF infections as the control group. Heparin-binding protein presented a substantially increased pattern in patients with postoperative meningitis or ventriculitis contrasted with control patients (180 [120-212] ng/mL in the infected group vs 12 [3-58] ng/mL in the controls). Heparin-binding protein achieved the highest area under the receiver operating characteristic curve of 0.93 (95% confidence interval, 0.91-0.96), a sensitivity of 89%, a specificity of 81%, a positive predictive value of 83%, and a negative predictive value of 87% with a cutoff value of >74 ng/mL, followed by lactate (0.90 [0.87-0.94]) and PCT (0.66 [0.60-0.73]). The protein was the only biomarker that elevated significantly in all culture-positive patients without the influence of empiric antibiotics.
CSF HBP is a more accurate candidate biomarker superior to lactate and PCT for diagnosing healthcare-associated meningitis and ventriculitis among pediatric patients. Early HBP analysis of CSF in suspected patients may facilitate early detection of CSF infections.
