Cerebrospinal Fluid Prognostic Index in Ventriculoperitoneal Shunt Infection

Background

Considering the consequences of shunt infection, the importance of early diagnosis and effective treatment becomes clear. However, there is no clear parameter to predict the management of shunt infection. Since we thought that an index including cerebrospinal fluid (CSF) leukocyte, glucose, and protein levels may affect treatment guidance, we aimed to investigate its effect on prognosis using the index we defined as CSF prognostic index.

Methods

Ventriculoperitoneal shunt infection patients' age, gender, etiology of hydrocephalus, serum glucose, leukocytes, white blood cell, C-reactive protein, CSF leukocyte, glucose, and leukoglycemic index (LGI) at admission were included. A new index was defined to include leukocyte, glucose, and protein values in CSF and investigate their effect on prognosis. CSF prognostic index = CSF leukocyte × CSF protein/CSF glucose.

Results

The study included 46 patients aged less than 18 years with shunt infection. There was no correlation among serum glucose, C-reactive protein, leukocytes, monocytes, lymphocytes, platelets, serum LGI, CSF LGI, and treatment duration. A positive correlation was found between CSF prognostic index and treatment duration, which was statistically significant (P = 0.011).

Conclusions

The CSF prognostic index is an index that can be easily evaluated with CSF findings at the time of presentation and can predict both the duration of treatment and the need for intrathecal treatment. Considering the use of broader spectrum antibiotherapies initially in patients with a high CSF prognostic index will avoid possible complications, provide less psychosocial impact on the patient and his/her relatives, and reduce the cost of treatment.