The Diagnostic And Therapeutic Value Of PCT,LA And LA/GLU In Cerebrospinal Fluid For Intracranial Infection After Craniotomy

Objective:By monitoring the dynamic changes of procalcitonin(PCT),lactic acid(LA),lactic acid/glucose(LA/GLU)and traditional indexes in cerebrospinal fluid of intracranial infection after craniotomy,the diagnostic and therapeutic value of each index for intracranial infection after craniotomy was discussed.Methods:A total of 152 patients with fever suspected of intracranial infection after craniotomy from June 1,2019 to February 1,2021 in the Department of Neurosurgery,Second Affiliated Hospital of Nanchang University were collected.During the diagnosis and treatment,79 patients who met the inclusion criteria were selected and divided into two groups: intracranial infection group(Group A+B)and non-intracranial infection group(Group control).The intracranial infection group was divided into two groups according to the symptoms and signs,laboratory examination and temperature improvement of the patients on the third day.Among them,the symptoms,signs and body temperature of patients in Group B did not improve on the third day,so they were treated with antibiotics immediately.In each group,the number of cases is distributed as fo llows: there are 34 cases in intracranial infection group(Group A+B)(21 cases in infection Group control and 13 cases in uncontrolled infection group),and 45 cases in non-intracranial infection group.Among them,the disease types of intracranial infection group(Group A+B)are: spontaneous cerebral hemorrhage in 26 cases,traumatic cerebral hemorrhage in 2 cases,brain tumor in 3cases and hydrocephalus in 3 cases.The disease types of non-intracranial infection group(Group control)were: spontaneous cerebral hemorrhage in 34 cases,traumatic cerebral hemorrhage in 2 cases,brain tumor in 4 cases and hydrocephalus in 5 cases.After each patient or their family members signed the informed consent for collecting cerebrospinal fluid and blood samples and c linical experimental research,the cerebrospinal fluid and peripheral venous blood samples of patients suspected of intracranial infection after craniotomy were collected on the 1st,3rd,5th,7th and14 th day respectively,among which the main features of suspected intracranial infection are fever and clinical manifestations similar to intracranial infection.PCT,LA,routine and biochemical tests were performed on the collected cerebrospinal fluid samples,and their LA/GLU(cerebrospinal fluid lactic acid /glucose)was calculated at the same time.Blood glucose,routine blood tests and biochemical tests were performed on the collected blood samples.The detection methods are as follows:(1)quantitative detection of PCT;in cerebrospinal fluid by electrochemical luminescence method;La in cerebrospinal fluid was detected by "endpoint colorimetry";Automatic detection of cerebrospinal fluid and blood routine by blood routine analyzer;The biochemistry and glucose of cerebrospinal fluid and blood were detected by DT380 automatic biochemical analyzer.Results:(1)On the first day of cerebrospinal fluid and blood test in patients with intracranial infection(Group A+B)and non-intracranial infection(Group control)of PCT,LA,LA/GLU,glucose,glucose/blood glucose,protein and WBC in cerebrospinal fluid of intracranial infection group(Group A+B)were higher than those of non-intracranial infection group,with statistical significance(p<0.05).Among them,PC T,LA and LA/GLU levels in cerebrospinal fluid of patients with intracranial infection were significantly higher than those of patients without intracranial infection,while glucose levels in cerebrospinal fluid were significantly lower than those of patients without intracra nial infection(P<0.0001).The receiver operating characteristic curve(ROC)analysis of PCT,LA and LA/GLU in cerebrospinal fluid showed that the Area Under C urve(AUC)of PC T in cerebrospinal fluid was 0.887,the threshold was 0.235ng/m L,the sensitivity was94.10%,and the specificity was 75.60%.The area under ROC curve(AUC)of cerebrospinal fluid LA was 0.866,the threshold was 3.115mmol/L,the sensitivity was 91.20%,and the specificity was 77.80%.The area under ROC curve(AUC)of CSF LA/GLU was 0.879,the threshold was 1.694,the sensitivity was 70.6%,and the specificity was 93.3%.(2)On the 1st,3rd,5th,7th and 14 th days of dynamic monitoring of PCT in cerebrospinal fluid of patients with intracranial infection Group control(Group A)and uncontrolled intracranial infection group(Group B): in the early stage of infection Group control,there was no significant difference in PCT between the two groups(P > 0.05).PC T in cerebrospinal fluid of the two groups changed from relatively significant difference(p<0.05)to significant difference(p<0.01),and then recovered to relatively significant difference(p<0.05).see table 4 and figure 5 for details.(3)On the 1st,3rd,5th,7th and 14 th days of dynamic monitoring of cerebrospinal fluid LA in patients with intracranial infection Group control(B group)and uncontrolled intracranial infection group(Group B),there were significant differences between patients in the early(1st day)and late(14th day)monitoring(P<0.01,P<0.05),while in the middle(3rd and 5th days).(4)On the 1st,3rd,5th,7th,14 th days of dynamic monitoring of cerebrospinal fluid LA/GLU in patients with intracranial infection Group control(Group A)and uncontrolled intracranial infection group(Group B): There was no statistical difference between the two groups in the early(1st day)and late(7th,14 th day)of monitoring(P>0.05).In the middle period of monitoring(the 3rd and 5th days),the LA/GLU ratio of cerebrospinal fluid between the two groups was significantly different(P<0.0001).The line chart showed that LA/GLU in cerebrospinal fluid of patients in Group B increased significantly on the third day without control,and decreased after changing antibiotics until it approached the level of patients in Group A.See Table 6,Figure 8 and Figure 9 for details.Conclusion:(1)PCT,LA and LA/GLU in cerebrospinal fluid of patients have good diagnostic value for intracranial infection of patient.(2)During the 14-day dynamic monitoring study,it was found that PCT,LA,LA/GLU in cerebrospinal fluid all have the ability to assess the disease,and compared with PCT in cerebrospinal fluid,LA,LA/Glu in cerebrospinal fluid have better ability to assess the disease.(3)CSF LA and LA/GLU have ROC curves similar to CSF sugar,which indicates that CSF LA/GLU has higher ability to distinguish intracranial infection than CSF LA and Glu.