title: Diagnosing external ventricular drain-related ventriculitis by means of local inflammatory response: soluble triggering receptor expressed on myeloid cells-1.
abstract: BACKGROUND
  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.
authors.forename: Monica
authors.initials: M
authors.lastname: Gordon
authors.forename: Paula
authors.initials: P
authors.lastname: Ramirez
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.forename: Manuel
authors.initials: M
authors.lastname: Palomo
authors.forename: Cristina
authors.initials: C
authors.lastname: Lopez-Ferraz
authors.forename: Esther
authors.initials: E
authors.lastname: Villarreal
authors.forename: Salome
authors.initials: S
authors.lastname: Meseguer
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Gomez
authors.forename: Carlos
authors.initials: C
authors.lastname: Folgado
authors.forename: Juan
authors.initials: J
authors.lastname: Bonastre
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D058565:Cerebral Ventriculitis / Q000175:diagnosis*; D016638:Critical Illness; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000628:therapy; D007249:Inflammation / Q000134:cerebrospinal fluid*; D007362:Intensive Care Units; D008297:Male; D008562:Membrane Glycoproteins / Q000276:immunology*; D008875:Middle Aged; D011446:Prospective Studies; D011971:Receptors, Immunologic / Q000276:immunology*; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
chemical_list: D015415:Biomarkers; D008562:Membrane Glycoproteins; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1