Research Of The Value Of Cerebrospinal Fluid PCT In The Early Diagnosis And Treatment Of Intracranial Infection In Patients With Fever After Craniotomy

Objective To evaluate the value of cerebrospinal fluid(CSF)procalcitonin(PCT)in the early diagnosis and treatment of intracranial infection in patients with fever after craniotomy.Methods A total of 960 patients after craniotomy in the department of neurosurgery,Anqing Affiliated Hospital of Anhui Medical University from January 2018 to July2019 were selected.With the informed consent of the patient or his family,CSF samples and peripheral venous blood samples were collected on days 1,3,5 and 7 after the fever.The CSF samples were collected for the following examination: CSF character,white blood cell(WBC),protein content,glucose content,chloride content,CSF PCT content and CSF bacteriological culture.Blood samples were collected to determine blood routine and serum PCT content.The CSF and serum WBC were examined by hand microscopy.CSF protein content and CSF sugar content were determined by colorimetry and hexokinase method respectively.CSF chloride content by selective electrode method;CSF PCT and serum PCT were electroluminescent.According to the diagnostic criteria and inclusion and exclusion criteria of intracranial infection,a total of 94 cases finally met the requirements.Among them,40 cases were diagnosed with intracranial infection,which were taken as samples of the infection group.There were 6 cases of craniocerebral tumor,19 cases of craniocerebral trauma and 15 cases of spontaneous intracerebral hemorrhage.There were 54 cases without intracranial infection,which were taken as samples of the non-infected group.There were 12 cases of craniocerebral tumor,23 cases of craniocerebral trauma and 19 cases of spontaneous intracerebral hemorrhage.Results On the first day of postoperative fever,the contents of serum PCT,CSF PCT,serum WBC,CSF WBC and CSF protein in the infected group were significantly higher than those in the control group(P < 0.05).The content of CSF sugar and chloride in the infected group was significantly lower than that in the control group(P < 0.05),both of which had statistical significance.According to receiver operating characteristic curve(ROC)analysis,CSF PCT has a high predictive value for the early diagnosis of intracranial infection in patients with fever after craniotomy,with an area of 0.861 under the curve,a sensitivity of 92.5% and a specificity of 72.2% at its theoretical threshold,and a significantly higher diagnostic accuracy than other indicators.40 patients with intracranial infection were treated with anti-infection therapy.Among them,24 patients with improved intracranial infection symptoms and laboratory parameters were included in the infection control group.There were still 16 cases with clinical symptoms and no improvement or even aggravation of laboratory parameters,which were classified as the non-control group of infection.The PCT value of CSF in the control group on the 3rd day of fever was significantly lower than that on the 1st day,with a statistically significant difference(P value was 0.048).However,CSF PCT in the non-control group remained at a high level.Since the third day of spontaneous fever,CSF PCT values in the infection control group and the non-control group were significantly different,with P values less than 0.05.Conclusion CSF PCT has certain clinical application value in the early diagnosis of intracranial infection in patients with fever after craniotomy,and the dynamic change of CSF PCT level has certain predictive value for the severity of intracranial infection and the effect of anti-infection treatment.