Acute Meningitis Prognosis Using Cerebrospinal Fluid Interleukin-6 Levels

• Published in: The Journal of emergency medicine 2012-08, Vol.43 (2), p.322-327
• Main Authors: Vázquez, Jorge Alejandro, MD, Adducci, Maria del Carmen, PhD, Coll, Carlos, PhD, Monzón, Daniel Godoy, MD, Iserson, Kenneth V., MD, MBA
• Format: Article
• Language: English
• Subjects: acute; Acute Disease; Adolescent; Adult; Aged; bacterial; cerebrospinal fluid; Cross-Sectional Studies; Emergency; Emergency Service, Hospital; Female; Fever - etiology; Headache - etiology; Hospitalization; Humans; interleukin-6; Interleukin-6 - cerebrospinal fluid; Male; meningitis; Meningitis, Aseptic - cerebrospinal fluid; Meningitis, Aseptic - diagnosis; Meningitis, Bacterial - cerebrospinal fluid; Meningitis, Bacterial - diagnosis; Meningitis, Haemophilus - cerebrospinal fluid; Meningitis, Haemophilus - diagnosis; Meningitis, Listeria - cerebrospinal fluid; Meningitis, Listeria - diagnosis; Meningitis, Meningococcal - cerebrospinal fluid; Meningitis, Meningococcal - diagnosis; Meningitis, Pneumococcal - cerebrospinal fluid; Meningitis, Pneumococcal - diagnosis; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Statistics, Nonparametric; Young Adult
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2011.07.029

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.