title: Diagnostic reliability of cerebral spinal fluid tests for acute confusional state (delirium) in patients with systemic lupus erythematosus: interleukin 6 (IL-6), IL-8, interferon-alpha, IgG index, and Q-albumin.
abstract: OBJECTIVE
  Acute confusional state (ACS) is an uncommon but severe central nervous system (CNS) syndrome in systemic lupus erythematosus (SLE) defined by clinical manifestations. To develop useful and reliable diagnostic tools for ACS, we evaluated the association of cerebral spinal fluid (CSF) tests with ACS and their predictive values for the diagnosis of ACS in SLE.
  
  
  METHODS
  We performed a prospective study using a cohort of 59 patients with SLE and compared those with and without ACS. Associations between ACS and each CSF test [interleukin 6 (IL-6), IL-8, interferon-alpha, IgG index, and Q-albumin] were statistically evaluated. Each patient underwent all CSF evaluations.
  
  
  RESULTS
  ACS was diagnosed in 10 patients (ACS group), SLE-related CNS syndromes except ACS in 13, and no CNS syndromes in 36 (non-CNS group). CSF IL-6 levels in the ACS group were significantly higher than those in the non-CNS group (p < 0.05). A positive IgG index (p = 0.028) was significantly associated with ACS. No other test showed a significant association with ACS. The positive and negative predictive values for the diagnosis of ACS in SLE were 80% and 85% for elevated CSF IL-6 levels (> or = 31.8 pg/ml), and 75% and 83% for the IgG index, respectively.
  
  
  CONCLUSIONS
  No single CSF test had sufficient predictive value to diagnose ACS in SLE, although CSF IL-6 levels and the IgG index showed statistical associations with ACS. Use of CSF tests combined with careful history and clinical examinations is recommended for proper diagnosis of ACS in SLE.
authors: Institute of Rheumatology ,Tokyo Women's Medical University, Tokyo, Japan. katsumata@ior.twmu.ac.jp
authors: Yasuhiro
authors: Y
authors: Katsumata
authors: Masayoshi
authors: M
authors: Harigai
authors: Yasushi
authors: Y
authors: Kawaguchi
authors: Chikako
authors: C
authors: Fukasawa
authors: Makoto
authors: M
authors: Soejima
authors: Kae
authors: K
authors: Takagi
authors: Michi
authors: M
authors: Tanaka
authors: Hisae
authors: H
authors: Ichida
authors: Akiko
authors: A
authors: Tochimoto
authors: Tokiko
authors: T
authors: Kanno
authors: Katsuji
authors: K
authors: Nishimura
authors: Naoyuki
authors: N
authors: Kamatani
authors: Masako
authors: M
authors: Hara
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003693:Delirium / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000134:cerebrospinal fluid; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D016209:Interleukin-8 / Q000134:cerebrospinal fluid; D008180:Lupus Erythematosus, Systemic / Q000134:cerebrospinal fluid / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
chemical_list: D016898:Interferon-alpha; D015850:Interleukin-6; D016209:Interleukin-8