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Utility of the Cell Index in Predicting External Ventricular Drain-Related Ventriculo-Meningitis

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Abstract

Background/Objective

Ventriculo-meningitis (VM) is an important complication of external ventricular drains (EVDs) in neurosurgical patients. Consequences include increased morbidity, mortality, and duration of hospital stay. Early diagnosis of EVD-associated VM allows earlier treatment intervention. The cell index (CI) may provide a simple measure that overcomes the limitations of isolated cerebrospinal fluid (CSF) parameters and other diagnostic tests, allowing earlier prediction of VM.

Methods

All patients admitted to a tertiary hospital and requiring EVD insertion during 2015 and 2016 were assessed for inclusion in this retrospective case–control study. Patients with a known or suspected intracranial infection were excluded. Of the 186 patients who underwent EVD insertion, 95 patients were included in the final cohort. Data pertaining to patient characteristics and laboratory indices were extracted from health records and the microbiology laboratory database. The CI was calculated as the ratio of temporally related CSF leukocytes/erythrocytes to peripheral blood leukocytes/erythrocytes. Data from patients with microbiologically confirmed VM were analyzed in comparison with those not developing VM during the course of their stay. Categorical and continuous variables with skewed distributions were analyzed by Chi square and Mann–Whitney tests, respectively.

Results

EVD-associated VM developed in 7.4% of patients. The highest CSF CI (within 3 days prior to diagnosis of VM or at any time for those not developing VM) differed significantly between the two groups (16; IQR 10.8–48.5 vs. 3.3; IQR 1.0–12.8, respectively; p = .046). The area under the receiver operating characteristic curve (AUROC) for the highest CI was 0.727 (95% confidence interval [CI] 0.526–0.929; p = .027). A CI of 10.4 provided a sensitivity and specificity of 80.5% and 70.5%, respectively, for the early diagnosis of VM.

Conclusions

In neurosurgical patients with an EVD, the CSF CI significantly predicted the development of VM.

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Funding

Intensive Care Unit, Sir Charles Gairdner Hospital.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Sarah Liew & Stephen Richards

  2. Department of Intensive Care Medicine, Royal Perth Hospital, Perth, WA, Australia

    Kwok Ming Ho

  3. School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia

    Kwok Ming Ho

  4. Faculty of Medicine and Health Science, University of Western Australia, Perth, WA, Australia

    Kwok Ming Ho

  5. Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Ronan Murray

  6. Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, WA, Australia

    Ronan Murray

  7. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia

    Ronan Murray

Authors
  1. Sarah Liew
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  2. Stephen Richards
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  3. Kwok Ming Ho
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  4. Ronan Murray
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Contributions

All authors contributed to drafting and critical revision of the manuscript. SL contributed to the study design and data collection. SR contributed to the study conception and design, data interpretation, and analysis. KMH conducted statistical analysis and interpretation of the data. RM provided clinical insights and contributed to data interpretation.

Corresponding author

Correspondence to Sarah Liew.

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Conflict of interest

The authors have no conflicts of interests to declare.

Ethical Approval

No ethics approval was deemed necessary for this study as assessed by the National Statement on Ethical Conduct in Human Research (5.1.22). This study has been exempt from review by the Sir Charles Gairdner Hospital Human Research and Ethics Committee, as assessed by the Sir Charles Gairdner Hospital Manager for Quality Improvement.

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Liew, S., Richards, S., Ho, K.M. et al. Utility of the Cell Index in Predicting External Ventricular Drain-Related Ventriculo-Meningitis. Neurocrit Care 33, 776–784 (2020). https://doi.org/10.1007/s12028-020-00964-w

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  • DOI: https://doi.org/10.1007/s12028-020-00964-w

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