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Measurement of Interleukin-6 (IL-6) to identify cerebrospinal fluid (CSF) infection in patients with external CSF drains

Anagnostopoulos, Georgios

[Thesis]. Manchester, UK: The University of Manchester; 2016.

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Abstract

Introduction: Cerebrospinal fluid (CSF) is produced in the central nervous system (CNS). In the event of flow obstruction or malabsorption a condition known as hydrocephalus occurs. External ventricular drains (EVD) and lumbar drains (LD) divert the CSF, thus reducing intracranial pressure (ICP). One of the most serious complications of drains is infection (ventriculitis). There is still on going debate amongst clinicians in an attempt to define CSF infection and the need for a biomarker that could assist in identifying CSF infection is evident. Interleukin-6 (IL-6) has been investigated for its potential use as an infection marker in different organ systems. It is the purpose of this study to assess the potential benefit from using IL-6 for early detection of CSF infection.Methods: The study was conducted in Salford Royal Foundation Trust. An infection panel convened retrospectively to assess the infection status of the patients. The panel was blinded to IL-6 results. Graphs of IL-6 were generated. A receiver operating characteristics (ROC) curve was also generated to assess sensitivity and specificity of IL-6 measurements for determining infection, as defined by the infection panel, using cut-off of >10000pg/ml for IL-6.Results: Thirty-six patients were recruited and clinical data from 33 patients was collected, together with serial CSF samples from each patient. Two hundred fifty nine CSF samples were collected along with clinical data regarding infection. IL- 6 data was plotted for the different sets of pathologies. ROC curve analysis determined a sensitivity of 80% (95% CI: 28.81% to 96.70%) and specificity of 85.71% (95% CI: 67.32% to 95.88%) for IL-6 diagnosis of infection.Discussion: The study was underpowered since it didn’t achieve the target number of participants or infections. However, the results indicate that IL-6 is associated with infection and suggest further multi-centered studies should be conducted to better evaluate the efficacy of IL-6 as a CSF infection marker.