Pathogen distribution and dynamic changes in inflammatory indicators in cerebrospinal fluid of patients with post-craniotomy nosocomial intracranial inflection and their diagnostic value

YAO Lan; GUO Fei; SONG Li; WANG Tuo; LIAO Xinhua

doi:10.3639/j.issn.1671-2897.2025.04.021

Abstract：Objective To analyze the pathogen distribution and dynamic changes of inflammatory indicators in cerebrospinal fluid of patients with post-craniotomy nosocomial intracranial infections and their related diagnostic values.Methods One hundred and fifty patients with suspected intracranial infections after neurosurgical cranio-cerebral surgery admitted to the First Affiliated Hospital of Xi'An JiaoTong University from February 2021 to February 2024 were selected,and the study subjects were divided into the infected group(n=44)and the non-infected group(n=106)according to the occurrence of intracranial infections.The basic data of patients in the two groups,the distribution of pathogenic bacteria in patients with postoperative intracranial infections,and the changes of inflammatory indicators in the cerebrospinal fluid were recorded and compared.Logistic regression modeling was used to analyze the factors associated with infection in patients;the diagnostic efficacy of patients'inflammatory indexes in cerebrospinal fluid was analyzed by comparing them with the receiver operating characteristic(ROC)curve.Results There were no statistically significant differences between the two groups in terms of gender,type of craniocerebral injury,duration of drain placement and co-morbidities(P>0.05),while there were statistically significant differences in terms of age,duration of surgery and GCS score(P<0.05).A total of 59 pathogenic bacteria were cultured and isolated from the infected group,of which Gram-positive bacteria accounted for 64.41%,with a total of 38 strains;Gram-negative bacteria accounted for 32.20%,with a total of 19 strains;and fungi accounted for 3.39%,with a total of 2 strains.The inflammatory indicators in the cerebrospinal fluid of the two groups were changing during the week of fever,and the difference of LDH was statistically significant on the 1st and 3rd day of fever(P<0.05),but not on the 7th day of fever(P>0.05);the difference of PCT and IL-6 was statistically significant on the 1st,3rd,and 7th day of fever(P<0.05);the difference of CRP was not statistically significant on day 1 of fever(P>0.05),but was statistically significant on days 3 and 7 of fever(P<0.05).Logistic regression analysis showed that LDH(days 1 and 3),PCT(days 1,3,and 7),IL-6(days 1,3,and 7),and CRP(days 3 and 7)were all associated with postoperative complications of infection in patients(P<0.05).ROC curve analysis showed that on the 1st day of fever,the area under the curve(AUC),sensitivity,of LDH and PCT were all higher than those of IL-6;on the 3rd day of fever,the AUC of PCT and IL-6 were higher than those of LDH and CRP;on the 7th day of fever,the AUC of CRP and PCT were higher than that of IL-6.Conclusion Dynamic changes in LDH,PCT,IL-6,and CRP in cerebrospinal fluid over the course of a week of fever are associated with intracranial infections and have some diagnostic value,suggesting that a combination of indicators should be combined with the dynamic trajectory of the indicators rather than a single point in time.