The Role of Cerebrospinal Fluid Biomarkers in the Diagnosis of Post-Neurosurgical Meningitis

Özet

AIM: To measure cytokine and lactate levels in the cerebrospinal fluid (CSF) of patients with suspected post-neurosurgical meningitis.MATERIAL and METHODS: Interleukin (IL)-8,-12, and -13, interferon (IFN) gamma, and lactate concentrations were determined inthe CSF of patients diagnosed with meningitis, who were undergoing follow-up after neurosurgical procedures at the NeurosurgeryClinic between May 2016 and November 2017. The demographic, clinical, biochemical, CSF cell count, CSF biochemistry, and CSFculture results of 119 patients were recorded.RESULTS: The study group consisted of 39 patients diagnosed with post-neurosurgical meningitis. The control group comprisedof 80 patients without pleocytosis, who had undergone lumbar puncture due to various indications. In the study group, 59% of thepatients had fever, 66.7% had deterioration in the level of consciousness, and 35.9% had neck stiffness. The levels of IL-8 (96.5ng/L vs. 86.6 ng/L, p<0.001), IL-12 (10.1 ng/L vs. 3 ng/L, p<0.001), and lactate (5.9 mmol/L vs. 2.1 mmol/L, p<0.001) were higherin the CSF of the patient group compared to the control group. However, IL-13 (32.7 ng/L vs. 42.5 ng/L, p=0.003) and IFN gamma(73.3 ng/L vs. 260.4 ng/L, p<0.001) levels were lower in patients compared to controls. The mortality rate in post-neurosurgicalmeningitis patients was estimated to be 35.9%.CONCLUSION: Post-neurosurgical meningitis prolongs the duration of hospital stay and causes long-term sequelae. Therefore,measurement of CSF cytokine and lactate levels alongside meningitis diagnostic processes may facilitate early and accuratediagnosis. Measuring CSF lactate is inexpensive and cost effective, particularly in post-neurosurgical patients.