1196. Roles of Biomarkers in Diagnosis of Infections in Febrile Post-Neurosurgical Patients
Session: Poster Abstract Session: Clinical Infectious Diseases: CNS Infection
Friday, October 28, 2016
Room: Poster Hall
Background:Clinical presentations and laboratory parameters in patients who develop fever following neurosurgery are indistinguishable between those with and without infections. We aimed to investigate the roles of serum and cerebrospinal fluid (CSF) biomarkers in differentiating the cause of fever in patients receiving neurosurgical interventions.

Methods:This is a prospective study in post-neurosurgical patients who developed fever within 14 days after operations, from January 2011 to June 2015. Clinical data and serum interleukin 6 (IL-6), lactate, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were collected. CSF analysis and CSF IL-6, lactate, LDH, and CRP were performed in those suspected meningitis. Factors associated with infections were analyzed using multiple logistic regression models.

Results: A total of 253 patients were enrolled. There were 138 and 115 patients classified as non-infection and infection, respectively. The most common cause of fever in the non-infection group was neurogenic central fever (42.7%). Among those who had infections, the most common infection was nosocomial pneumonia (20.2%), followed by central nervous system (CNS) infection (10.7%). In multivariate analysis, the independent factors associated with overall infections (adjusted odds ratio [OR]; 95% confidence interval [CI]; p-value) were older age (1.03; 1.01-1.05; p 0.015), ventriculostomy (2.34; 1.09-5.03; p 0.030), presence of phlebitis (24.14; 2.53-230.06; p 0.006), mechanical ventilator (3.02; 1.38-6.59; p 0.006), serum lactate ≥ 2 mmol/L (2.75; 1.29-5.90; p 0.009), serum CRP ≥ 90 mg/L (2.27; 1.07-4.83; p 0.034) and serum LDH ≥ 450 U/L (2.64; 1.23-5.64; p 0.012). Twenty-seven patients developed CNS infections. The independent factors associated with CNS infections (adjusted OR; 95% CI; p-value) were CSF lactate ≥ 5 mmol/L (27.40; 2.08-360.47; p 0.012), CSF IL-6 ≥ 4000 pg/mL (7.42; 1.24-44.32; p 0.028) and male gender (7.42; 1.24-44.32; p0.028).

Conclusion: In addition to clinical factors, serum lactate ≥ 2 mmol/L, CRP ≥ 90 mg/L and LDH ≥ 450 U/L were associated with overall infections in febrile post-neurosurgical patients, whereas CSF lactate ≥ 5 mmol/L and CSF IL-6 ≥ 4000 pg/mL were associated with CNS infections.

Methee Chayakulkeeree, MD, PhD1, Pongnuch Boonyapaisancharoen, MD2, Patcharawan Yuckpan, MD2, Jaruda Kobkitjaroen, MD3 and Sarun Nunta-Aree, MD, PhD4, (1)Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, (2)Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, (3)Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, (4)Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand


M. Chayakulkeeree, None

P. Boonyapaisancharoen, None

P. Yuckpan, None

J. Kobkitjaroen, None

S. Nunta-Aree, None

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