Clinical Analysis Of Fever-related Factors And Changes Of Serum And Cerebrospinal Fluid Inflammatory Indicators After Craniotomy

ObjectiveWe collected the clinical data of patients with postoperative fever who underwent craniotomy in our center,and analyzed the expression levels and trends of inflammatory indicators in serum and cerebrospinal fluid,and explored the predictive and diagnostic values of inflammatory indicators in different media for intracranial infection.To explore the related risk factors of postoperative fever,and provide new ideas for early diagnosis of intracranial infection and prevention of postoperative fever.MethodsBy retrospectively analyzing the clinical data of patients with postoperative who underwent craniotomy in our center from October 1^st,2021 to December 31^st,2022.According to the diagnostic criteria of intracranial infection and inclusion-exclusion criteria,they were divided into infection group（A+B group）and non-infection group（Control group）.The patients in the infection group were dynamically monitored for one week.If the clinical symptoms disappeared after one week,the laboratory test results returned to normal,and the cerebrospinal fluid bacterial culture identification results were negative,the subjects in the infection group could be classified as infection control group（A）.If the patient’s clinical symptoms still existed after one week,the laboratory results were still abnormal,and the cerebrospinal fluid bacterial culture identification results were positive,these subjects were classified as the infection uncontrolled group（B）.We collected the basic information,peripheral venous blood inflammatory indicators,cerebrospinal fluid inflammatory indicators,perioperative data,body temperature changes and other data of each group of patients.SPSS 26.0software and Graph Pad Prism 9 were used for data statistical analysis and mapping.The levels and changes of various inflammatory indicators in the two groups were compared,and the related factors affecting postoperative fever were analyzed.When the statistical test result was P<0.05,the data were considered statistical difference.ResultsA total of 108 patients who met the criteria were collected in this study,including33 patients（30.56%）in the infected group and 75 patients（69.44%）in the uninfected group.There were 49 males（45.37%）and 59 females（54.63%）.There were 21 cases of cerebrovascular disease（19.44%）,75 cases of intracranial tumor（69.44%）,7 cases of craniocerebral injury and hemorrhage（6.48%）and 5 cases of functional neurosurgery disease（4.64%）.（1）Multivariate Logistic regression analysis showed that the OR value of surgical approach was 2.063,95%confidence interval was 1.333-3.192,P=0.001;the OR value of surgical timing was 2.100,95%confidence interval was 1.355-3.256,P=0.001;the OR value of external drainage tube was 1.919,95%confidence interval was 1.222-3.012,P=0.005;surgical approach,timing of operation and placement of external drainage tube were all risk factors for postoperative fever of craniotomy.（2）The results of CRP test in the two groups showed that there was no significant difference in serum CRP between the infected group and the uninfected group on the first,third and seventh days after fever（P>0.05）.There was no significant difference in cerebrospinal fluid CRP between the infected group and the uninfected group on the first day after fever（P>0.05）,but there was significant difference on the third and seventh days after fever（P<0.05）,and the cerebrospinal fluid CRP level in the infected group gradually decreased with time.According to the ROC curve of cerebrospinal fluid CRP,its specificity is higher in the middle and late stages of infection.（3）The results of LDH test in the two groups showed that there was no significant difference in serum LDH between the infected group and the uninfected group on the1st,3rd and 7th day after fever（P>0.05）.There was a statistically significant difference in cerebrospinal fluid LDH between the infected group and the uninfected group on the first day after fever（P<0.05）.According to the ROC curve of cerebrospinal fluid LDH,cerebrospinal fluid LDH has a high sensitivity in the early stage of infection,but the specificity is low.（4）The results of IL-6 test in the two groups showed that there was a statistical difference in serum IL-6 between the infected group and the uninfected group on the first day after fever（P<0.05）.The cerebrospinal fluid IL-6 in the infected group and the uninfected group was statistically different on the 1st,3rd and 7th days after fever（P<0.05）.According to the ROC curve of serum IL-6 and cerebrospinal fluid IL-6,serum IL-6 has certain predictive value in the early stage of infection;the specificity of cerebrospinal fluid IL-6 gradually increased over time.（5）The results of PCT test in the two groups showed that there was a statistical difference in serum PCT between the infected group and the uninfected group on the first and third days after fever（P<0.05）.There were significant differences in cerebrospinal fluid PCT between the infected group and the uninfected group on the 1st,3rd and 7th days after fever（P<0.001）.Serum PCT has certain diagnostic value in the early stage of infection.Cerebrospinal fluid PCT has predictive and diagnostic value in the early and middle stages of infection.（6）The detection results of cerebrospinal fluid PCT/serum PCT in the two groups showed that the cerebrospinal fluid PCT/serum PCT in the infected group and the uninfected group were statistically different on the first and seventh days of fever（P<0.05）,and there was no significant difference between the two groups on the third days after fever（P>0.05）.Cerebrospinal fluid PCT/serum PCT has certain diagnostic value for intracranial infection.Conclusion1.Surgical approach,timing of surgery,and placement of external drainage tube are risk factors for postoperative fever of craniotomy.2.The changes of serum PCT,cerebrospinal fluid PCT,IL-6 and PCT within 1week after fever proved that these four inflammatory indicators had good diagnostic value and disease assessment ability for intracranial infection.3.Cerebrospinal fluid PCT/serum PCT also has a good evaluation value for the early diagnosis of intracranial infection.