Diagnosing external ventricular drain-related ventriculitis by means of local inflammatory response: soluble triggering receptor expressed on myeloid cells-1 View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-10-20

AUTHORS

Monica Gordon, Paula Ramirez, Alex Soriano, Manuel Palomo, Cristina Lopez-Ferraz, Esther Villarreal, Salome Meseguer, Maria Dolores Gomez, Carlos Folgado, Juan Bonastre

ABSTRACT

IntroductionExternal ventricular drainage (EVD)-related ventriculitis is one of the most severe complications associated with the use of EVDs. Establishing an early and certain diagnosis can be difficult in critically ill patients. We performed this prospective study to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determination in cerebrospinal fluid (CSF) in the diagnosis of ventriculitis.MethodsA prospective observational study was conducted of 73 consecutive patients with EVD. Samples of CSF for culture, cytobiochemical analysis and sTREM-1 determination were extracted three times a week. Ventriculitis diagnosis required a combination of microbiological, cytobiochemical and clinical criteria.ResultsSeventy-three consecutive patients were included. EVD-related ventriculitis was diagnosed in six patients and EVD-colonization in ten patients. Patients without clinical or microbiological findings were considered controls. The median CSF sTREM-1 was 4,320 pg/ml (interquartile range (IQR): 2,987 to 4,886) versus 266 pg/ml (118 to 689); P <0.001. There were no differences when comparing colonized-patients and controls. The best cut-off sTREM-1 value for the diagnosis of ventriculitis was 2,388.79 pg/ml (sensitivity 100%, specificity 98.5%, positive predictive value 85.71%, negative predictive value 100%). CSF proteins, glucose and the ratio CSF/serum glucose were also significantly different (P = 0.001). Serum biomarkers were not useful to diagnose EVD-related infection. These results were confirmed by a case°Control study with ventriculitis patients (cases) and non-ventriculitis (control subjects) matched by age, comorbidities, severity scales and EVD duration (P = 0.004).ConclusionsCSF sTREM-1 was useful in the diagnosis of ventriculitis, in a similar measure to classical CSF parameters. Furthermore, CSF sTREM-1 could prove the diagnosis in uncertain cases and discriminate between EVD-colonization and infection. More... »

PAGES

567

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13054-014-0567-0

DOI

http://dx.doi.org/10.1186/s13054-014-0567-0

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PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25327849


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32 schema:description IntroductionExternal ventricular drainage (EVD)-related ventriculitis is one of the most severe complications associated with the use of EVDs. Establishing an early and certain diagnosis can be difficult in critically ill patients. We performed this prospective study to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determination in cerebrospinal fluid (CSF) in the diagnosis of ventriculitis.MethodsA prospective observational study was conducted of 73 consecutive patients with EVD. Samples of CSF for culture, cytobiochemical analysis and sTREM-1 determination were extracted three times a week. Ventriculitis diagnosis required a combination of microbiological, cytobiochemical and clinical criteria.ResultsSeventy-three consecutive patients were included. EVD-related ventriculitis was diagnosed in six patients and EVD-colonization in ten patients. Patients without clinical or microbiological findings were considered controls. The median CSF sTREM-1 was 4,320 pg/ml (interquartile range (IQR): 2,987 to 4,886) versus 266 pg/ml (118 to 689); P <0.001. There were no differences when comparing colonized-patients and controls. The best cut-off sTREM-1 value for the diagnosis of ventriculitis was 2,388.79 pg/ml (sensitivity 100%, specificity 98.5%, positive predictive value 85.71%, negative predictive value 100%). CSF proteins, glucose and the ratio CSF/serum glucose were also significantly different (P = 0.001). Serum biomarkers were not useful to diagnose EVD-related infection. These results were confirmed by a case°Control study with ventriculitis patients (cases) and non-ventriculitis (control subjects) matched by age, comorbidities, severity scales and EVD duration (P = 0.004).ConclusionsCSF sTREM-1 was useful in the diagnosis of ventriculitis, in a similar measure to classical CSF parameters. Furthermore, CSF sTREM-1 could prove the diagnosis in uncertain cases and discriminate between EVD-colonization and infection.
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39 schema:keywords CSF parameters
40 CSF protein
41 EVD
42 EVD duration
43 Severity Scale
44 age
45 analysis
46 biomarkers
47 cases
48 cells 1
49 cerebrospinal fluid
50 certain diagnosis
51 clinical criteria
52 combination
53 comorbidities
54 complications
55 consecutive patients
56 control
57 criteria
58 culture
59 determination
60 diagnosis
61 diagnosis of ventriculitis
62 differences
63 drainage
64 duration
65 findings
66 fluid
67 glucose
68 ill patients
69 infection
70 inflammatory response
71 local inflammatory response
72 means
73 measures
74 microbiological findings
75 myeloid cells-1
76 observational study
77 parameters
78 patients
79 pg/
80 prospective observational study
81 prospective study
82 protein
83 receptors
84 response
85 results
86 sTREM-1
87 samples
88 samples of CSF
89 scale
90 serum biomarkers
91 serum glucose
92 severe complications
93 similar measures
94 study
95 time
96 uncertain cases
97 use
98 usefulness
99 values
100 ventricular drainage
101 ventriculitis
102 weeks
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