Cerebrospinal fluid tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-8 as diagnostic markers of cerebrospinal fluid infection in neurosurgical patients.
OBJECTIVE
To evaluate whether cerebrospinal fluid concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, or IL-8 may be used as diagnostic markers for the differential diagnosis of aseptic vs. bacterial meningitis and/or ventriculitis in neurosurgical patients.


METHODS
Prospective, observational study.


METHODS
University teaching hospital.


METHODS
A total of 112 cerebrospinal fluid samples from 14 asymptomatic patients with normal cerebrospinal fluid after neurosurgery, 27 asymptomatic and 19 symptomatic patients with postneurosurgical aseptic meningitis, 32 patients with postneurosurgical cerebrospinal fluid infection, and 20 with severe subarachnoid and/or cerebral hemorrhage.


RESULTS
Specific ELISA kits were used to analyze TNF-alpha, IL-1beta, IL-6, and IL-8 concentrations on cerebrospinal fluid samples. Elevations in cerebrospinal fluid concentrations of TNF-alpha, IL-1beta, IL-6, and IL-8 were induced by different diseases or neurosurgical procedures, but cerebrospinal fluid bacterial infection induced the highest concentrations. To discriminate between aseptic cerebrospinal fluid pleocytosis and cerebrospinal fluid infection with a specificity of 95%, cerebrospinal fluid leukocyte count >1700/mL, TNF-alpha >150 pg/mL, and IL-1beta >90 pg/mL showed sensitivities of 51%, 74%, and 90%, respectively. Sufficiently sensitive and specific cutoff points could not be found for cerebrospinal fluid IL-6 or IL-8.


CONCLUSIONS
Cerebrospinal fluid IL-1beta appears to be the best biochemical marker of cerebrospinal fluid infection in neurosurgical patients.
López-Cortés
L F
LF
Infectious Diseases Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain. lflopez@cica.es
Marquez-Arbizu
R
R
Jimenez-Jimenez
L M
LM
Jimenez-Mejías
E
E
Caballero-Granado
F J
FJ
Rey-Romero
C
C
Polaina
M
M
Pachón
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000134:cerebrospinal fluid; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000134:cerebrospinal fluid*; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis / Q000276:immunology; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000134:cerebrospinal fluid; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D016209:Interleukin-8 / Q000134:cerebrospinal fluid; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis / Q000276:immunology; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000276:immunology; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000134:cerebrospinal fluid
D015415:Biomarkers; D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha