Diagnosing external ventricular drain-related ventriculitis by means of local inflammatory response: soluble triggering receptor expressed on myeloid cells-1Report as inadecuate

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Critical Care

, 18:567

First Online: 20 October 2014Received: 05 May 2014Accepted: 02 October 2014


IntroductionExternal 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.

MethodsA 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.

ResultsSeventy-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.

ConclusionsCSF 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.

AbbreviationsAPACHE IIAcute Physiology and Chronic Health Evaluation II

AUCarea under the curve

CICchronic ischemic cardiomyopathy

CRBcatheter related bacteremia

CRIchronic renal insufficiency

CRPC-reactive protein

CSFcerebrospinal fluid

CVAcerebrovascular accident

EVDexternal ventricular drainage

GCSGlasgow Coma Scale

ICHintracerebral hemorrhage

ICUintensive care unit

IgG1immunoglobulin G 1

IQRinterquartile range

IVHintraventricular hemorrhage

LR+positive likelihood ratio

LR-negative likelihood ratio

NPVnegative predictive value


PPVpositive predictive value

PVCpolyvinyl chloride

ROCreceiver operating characteristic

SAHsubarachnoid hemorrhage

sTREM-1soluble triggering receptor expressed on myeloid cells-1

TNFαtumor necrosis factor

TRACETime-Resolved Amplified Crypate Emission

UTIurinary tract infection

VAPventilator-associated pneumonia

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0567-0 contains supplementary material, which is available to authorized users.

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Author: Monica Gordon - Paula Ramirez - Alex Soriano - Manuel Palomo - Cristina Lopez-Ferraz - Esther Villarreal - Salome Meseguer

Source: https://link.springer.com/

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