Acute meningitis prognosis using cerebrospinal fluid interleukin-6 levels.

Abstract

BACKGROUND:

Improved diagnostic tests would aid in diagnosing and treating community-acquired meningitis.

OBJECTIVE:

To analyze the diagnostic value of interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) of patients presenting with symptoms of acute meningitis.

MATERIAL AND METHODS:

In a 6-month prospective, observational, cross-sectional emergency department (ED) study, serum and CSF samples were obtained from all patients with a headache and fever in whom the physician suspected meningitis. Patients were excluded if computed tomography findings contraindicated a lumbar puncture, if they had bleeding disorders, or if their serum indicated bleeding. IL-6 levels were measured and compared in patients with (Group A) and without (Group B) bacterial meningitis.

RESULTS:

Samples were obtained from 53 patients, of whom 40 were ultimately found to have meningitis. These 40 patients averaged 49.6 ± 21.9 years, with number of men 18 (45%), hospitalizations 21 (52%), mortality 3 (.07%), and IL-6 average rating 491 (median: 14.5; range 0000-6000). Findings in the two groups were: Group A (with meningitis): n = 13, average IL-6 level: 1495 (median: 604; 25/75 percentiles: 232.5-2030; 95% confidence interval [CI] 371.7-2618.6; range 64-6000). Group B (with aseptic meningitis): n = 27, average IL-6 level: 7.34 (median: 5; 25/75 percentiles: 0.0/15.1; 95% CI 3.94-10.73; range 0-23.6). Mann-Whitney rank sum test: p < 0.0001.

CONCLUSIONS:

In patients with acute bacterial meningitis, CSF cytokine concentrations are elevated. Measuring CSF inflammatory cytokine levels in patients with acute meningitis could be a valuable ED diagnostic tool. Using this tool could improve the prognosis of patients with bacterial meningitis by allowing more rapid initiation of antibiotic treatment.

• Authors: Jorge Alejandro Vázquez, Maria del Carmen Adducci, Carlos Coll, Daniel Godoy Monzón, Kenneth V Iserson
• Journal: The Journal of emergency medicine (J Emerg Med) Vol. 43 Issue 2 Pg. 322-7 (Aug 2012) ISSN: 0736-4679 [Print] United States
• PMID: 22142673 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Interleukin-6

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Cross-Sectional Studies
• Emergency Service, Hospital
• Female
• Fever (etiology)
• Headache (etiology)
• Hospitalization
• Humans
• Interleukin-6 (cerebrospinal fluid)
• Male
• Meningitis, Aseptic (cerebrospinal fluid, diagnosis)
• Meningitis, Bacterial (cerebrospinal fluid, diagnosis)
• Meningitis, Haemophilus (cerebrospinal fluid, diagnosis)
• Meningitis, Listeria (cerebrospinal fluid, diagnosis)
• Meningitis, Meningococcal (cerebrospinal fluid, diagnosis)
• Meningitis, Pneumococcal (cerebrospinal fluid, diagnosis)
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Statistics, Nonparametric
• Young Adult