Cerebrospinal fluid tumor necrosis factor-alpha, interleukin-beta, interleukin-6, and inteuleukin-8 as diagnostic markers of cerebrospinal fluid infection in neurosurgical patients

Objective: To evaluate whether cerebrospinal fluid concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-6, or IL-8 may be used as diagnostic markers for the differential diagnosis of aseptic vs. ba cterial meningitis and/or ventriculitis in neurosurgical patients, Design: Prospective, observational study. Setting: University teaching hospital. Subjects: A total of 112 cerebrospinal fluid samples from 14 asymptomatic p atients with normal cerebrospinal fluid after neurosurgery, 27 asymptomatic and 19 symptomatic patients with postneurosurgical aseptic meningitis, 32 patients with postneurosurgical cerebrospinal fluid infection, and 20 with severe subarachnoid and/or cerebral hemorrhage, Measurements and Main Results: Specific ELISA kits were used to analyze TNF -alpha, IL-1 beta, IL-6, and IL-8 concentrations on cerebrospinal fluid sam ples. Elevations in cerebrospinal fluid concentrations of TNF-alpha, IL-1 b eta, IL-6, and IL-8 were induced by different diseases or neurosurgical pro cedures, but cerebrospinal fluid bacterial infection induced the highest co ncentrations. To discriminate between aseptic cerebrospinal fluid pleocytos is and cerebrospinal fluid infection with a specificity of 95%, cerebrospin al fluid leukocyte count >1700/mL, TNF-alpha >150 pg/mL, and Il-1 beta >90 pg/mL showed sensitivities of 51%, 74%, and 90%, respectively. Sufficiently sensitive and specific cutoff points could not he found for cerebrospinal fluid IL-S or IL-8. Conclusion: Cerebrospinal fluid IL-1 beta appears to be the best biochemica l marker of cerebrospinal fluid infection in neurosurgical patients.