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

INTRODUCTION: External 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. METHODS: A 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. RESULTS: Seventy-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). CONCLUSIONS: CSF 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

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1005506360

PUBMED

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


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32 schema:description INTRODUCTION: External 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. METHODS: A 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. RESULTS: Seventy-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). CONCLUSIONS: CSF 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 CSF sTREM-1
42 CSF/serum glucose
43 EVD
44 EVD duration
45 EVD-colonization
46 Severity Scale
47 Ventriculitis diagnosis
48 age
49 analysis
50 biomarkers
51 case-control study
52 cases
53 cells 1
54 cells-1 (sTREM-1) determination
55 cerebrospinal fluid
56 certain diagnosis
57 classical CSF parameters
58 clinical criteria
59 combination
60 comorbidities
61 complications
62 consecutive patients
63 control
64 criteria
65 culture
66 cytobiochemical analysis
67 determination
68 diagnosis
69 diagnosis of ventriculitis
70 differences
71 drain-related ventriculitis
72 drainage
73 duration
74 external ventricular drain-related ventriculitis
75 external ventricular drainage
76 findings
77 fluid
78 glucose
79 ill patients
80 infection
81 inflammatory response
82 local inflammatory response
83 means
84 measures
85 median CSF sTREM-1
86 microbiological findings
87 myeloid cells-1
88 myeloid cells-1 (sTREM-1) determination
89 observational study
90 parameters
91 patients
92 pg/
93 prospective observational study
94 prospective study
95 protein
96 ratio CSF/serum glucose
97 receptors
98 response
99 results
100 sTREM-1
101 samples
102 samples of CSF
103 scale
104 serum biomarkers
105 serum glucose
106 severe complications
107 similar measures
108 study
109 time
110 uncertain cases
111 use
112 use of EVDs
113 usefulness
114 values
115 ventricular drain-related ventriculitis
116 ventricular drainage
117 ventriculitis
118 ventriculitis patients
119 weeks
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