The additional diagnostic contribution of cerebrospinal fluid cytokine levels to the routine assessment of cerebrospinal fluid in the diagnosis of ventriculitis

Object: Ventriculitis associated with shunt infections are high cost infections and there are such difficulties in diagnosis and treatment. These infecions are long term treatment required infections and reproduction of the infectious agent in cerebrospinal fluid(CSF) culture is needed for the definitive diagnosis. The emergence culture results take up to 48-72 hours so the diagnosis is often recorded as delayed. The new parameters are sought to direct the treatment without the need to wait for the culture outcome. In our study proinflammatory cytokines IL-1β and TNFα are evaluated in CSF to questione how effective parameters are these in the diagnosis of ventriculitis. Material-methods: 34 patients with ventriculoperitoneal shunt or external ventricular drainage catheter inserted are enrolled to study between December 2012-December 2013 in the suspicy of ventriculitis. The study group consists of two subgroups; patient group(19 patients) and control group(15 patients). Blood and CSF samples are gathered and evaluated in the mean time. WBC, ESR, CRP, IL-1β, TNFα and CSF culture results are used for diagnostic parameters. Findings: IL-1β raises more reliable in patient group versus control group(p:0,0001). Patients with positive CSF culture accepted as ventriculitis; IL-1β is found significantly higher in patients when comparing patients with negative CSF culture outcome(p:0,009). IL-1β values over 4.0pg/ml; the probability of predicting positive culture outcome is %92.7 with %90.9 sensitivity and %82.6 specifity. TNFα values do not show significant reliable pattern as compared to IL-1β. Results: IL-1β is a reliable parameter which shall be used in the diagnosis of ventriculitis by predicting positive culture outcome with high sensitivity and specifity. Key words: IL-1β, shunt infections, TNFα, ventriculitis