Turkish Neurosurgery
The Role of Cerebrospinal Fluid Biomarkers in the Diagnosis of Post-Neurosurgical Meningitis
gülnur kul1, irfan şencan2, halil kul3, nesibe korkmaz4, enes altunay5
1kırıkhan devlet hastanesi, enfeksiyon hastalıkları ve klinik mikrobiyoloji, kırıkhan/hatay,
2Dışkapı Yıldırım Beyazıt Education Research Hospital , Infectious Disease , ankara,
3hatay state hospital, neurosurgery, hatay,
4ağrı state hospital, Infectious Disease , ağrı,
5Dışkapı Yıldırım Beyazıt Education Research Hospital , clinic microbiology, ankara,
DOI: 10.5137/1019-5149.JTN.25175-18.2
Aim:This study aimed to measure cytokine and lactate levels in the cerebrospinal fluid (CSF) of patients with suspected post-neurosurgical meningitis. Material and Methods:: Interleukin-8,12,and 13, interferon gamma, and lactate concentrations were determined in the CSF of patients diagnosed with meningitis, who were undergoing follow-up after neurosurgical procedures at the Neurosurgery Clinic between May 2016 and November 2017. The demographic, clinical, biochemical, CSF cell count, CSF biochemistry, and CSF culture results of 119 patients were recorded.Results:The study group consisted of 39 patients diagnosed with post-neurosurgical meningitis. The control group comprised of 80 patients without pleocytosis, who had undergone lumbar puncture due to various indications. In the study group, 59% of the patients had fever, 66.7% had deterioration in the level of consciousness, and 35.9% had neck stiffness. The levels of interleukin-8 (96.5ng/L vs. 86.6ng/L, p < 0.001), interleukin-12 (10.1ng/L vs. 3ng/L, p < 0.001), and lactate (5.9 mmol/L vs. 2.1 mmol/L, p < 0.001) were higher in the CSF of the patient group compared to the control group. However,interleukin-13 (32.7ng/L vs. 42.5ng/L, p = 0.003) and interferon gamma (73.3ng/L vs. 260.4ng/L, p < 0.001) levels were lower in patients compared to controls. The mortality rate in post-neurosurgical meningitis patients was estimated to be 35.9%.Conclusion:Post-neurosurgical meningitis prolongs the duration of hospital stay and causes long-term sequelae. Therefore, measurement of CSF cytokine and lactate levels alongside meningitis diagnostic processes may facilitate early and accurate diagnosis. Measuring CSF lactate is inexpensive and cost effective, particularly in post-neurosurgical patients.
Corresponding author : gülnur kul