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Heparin-binding protein as a marker of ventriculostomy related infection and central nervous system inflammation in neuro-intensive care

Widén, Johan LU ; Cederberg, David LU ; Linder, Adam LU and Westman, Gabriel LU (2023) In Clinical Neurology and Neurosurgery 229.
Abstract

Objective: Diagnosis of ventriculostomy related infections (VRI) in the neuro-intensive care unit remains challenging and current biomarkers lack adequate precision. The aim of this study was to explore the potential of Heparin-binding protein (HBP) in cerebrospinal fluid (CSF) as a diagnostic biomarker of VRI. Methods: All patients treated with an external ventricular drain (EVD) between January 2009 and March 2010 at Skåne university hospital in Lund, Sweden, were consecutively included. CSF samples obtained during routine care were analyzed for HBP. VRI was defined as a positive bacterial microbiology test result on a CSF sample with an erythrocyte-corrected leukocyte count of > 50 × 106/l. HBP levels at VRI diagnosis... (More)

Objective: Diagnosis of ventriculostomy related infections (VRI) in the neuro-intensive care unit remains challenging and current biomarkers lack adequate precision. The aim of this study was to explore the potential of Heparin-binding protein (HBP) in cerebrospinal fluid (CSF) as a diagnostic biomarker of VRI. Methods: All patients treated with an external ventricular drain (EVD) between January 2009 and March 2010 at Skåne university hospital in Lund, Sweden, were consecutively included. CSF samples obtained during routine care were analyzed for HBP. VRI was defined as a positive bacterial microbiology test result on a CSF sample with an erythrocyte-corrected leukocyte count of > 50 × 106/l. HBP levels at VRI diagnosis was compared to peak HBP levels in non-VRI controls. Results: In total, 394 CSF samples from 103 patients were analyzed for HBP. Seven patients (6.8%) fulfilled VRI criteria. Levels of HBP were significantly higher in VRI subjects (31.7 ng/mL [IQR 26.9–40.7 ng/mL]) compared to non-VRI controls (7.7 ng/mL [IQR 4.1–24.5 ng/mL]) (p = 0.024). The AUC of the receiver operating characteristic (ROC) curve was 0.76 (95% confidence interval [CI], 0.62–0.90). Among non-VRI patients, HBP was highest in patients with acute bacterial meningitis. Patients with subarachnoid hemorrhage displayed higher HBP levels than those with traumatic brain injury or shunt dysfunction. Conclusions: HBP levels were higher in VRI subjects and varied between patients and different diagnoses. To validate the clinical usefulness and added value of HBP as a biomarker for VRI, the results need to be confirmed in larger studies with head-to-head comparisons to current biomarkers.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cerebrospinal fluid, External ventricular drain, Heparin-binding protein, Ventriculostomy related infection
in
Clinical Neurology and Neurosurgery
volume
229
article number
107752
publisher
Elsevier
external identifiers
  • pmid:37156040
  • scopus:85156111037
ISSN
0303-8467
DOI
10.1016/j.clineuro.2023.107752
language
English
LU publication?
yes
id
8195528f-1247-4fe2-8d47-76c6b80a00c3
date added to LUP
2023-08-10 11:40:57
date last changed
2024-04-20 00:18:34
@article{8195528f-1247-4fe2-8d47-76c6b80a00c3,
  abstract     = {{<p>Objective: Diagnosis of ventriculostomy related infections (VRI) in the neuro-intensive care unit remains challenging and current biomarkers lack adequate precision. The aim of this study was to explore the potential of Heparin-binding protein (HBP) in cerebrospinal fluid (CSF) as a diagnostic biomarker of VRI. Methods: All patients treated with an external ventricular drain (EVD) between January 2009 and March 2010 at Skåne university hospital in Lund, Sweden, were consecutively included. CSF samples obtained during routine care were analyzed for HBP. VRI was defined as a positive bacterial microbiology test result on a CSF sample with an erythrocyte-corrected leukocyte count of &gt; 50 × 10<sup>6</sup>/l. HBP levels at VRI diagnosis was compared to peak HBP levels in non-VRI controls. Results: In total, 394 CSF samples from 103 patients were analyzed for HBP. Seven patients (6.8%) fulfilled VRI criteria. Levels of HBP were significantly higher in VRI subjects (31.7 ng/mL [IQR 26.9–40.7 ng/mL]) compared to non-VRI controls (7.7 ng/mL [IQR 4.1–24.5 ng/mL]) (p = 0.024). The AUC of the receiver operating characteristic (ROC) curve was 0.76 (95% confidence interval [CI], 0.62–0.90). Among non-VRI patients, HBP was highest in patients with acute bacterial meningitis. Patients with subarachnoid hemorrhage displayed higher HBP levels than those with traumatic brain injury or shunt dysfunction. Conclusions: HBP levels were higher in VRI subjects and varied between patients and different diagnoses. To validate the clinical usefulness and added value of HBP as a biomarker for VRI, the results need to be confirmed in larger studies with head-to-head comparisons to current biomarkers.</p>}},
  author       = {{Widén, Johan and Cederberg, David and Linder, Adam and Westman, Gabriel}},
  issn         = {{0303-8467}},
  keywords     = {{Cerebrospinal fluid; External ventricular drain; Heparin-binding protein; Ventriculostomy related infection}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Clinical Neurology and Neurosurgery}},
  title        = {{Heparin-binding protein as a marker of ventriculostomy related infection and central nervous system inflammation in neuro-intensive care}},
  url          = {{http://dx.doi.org/10.1016/j.clineuro.2023.107752}},
  doi          = {{10.1016/j.clineuro.2023.107752}},
  volume       = {{229}},
  year         = {{2023}},
}