AUTHOR=Zhang Huan , He Xiaozheng , Xie Linghai , Zhang Hongbo , Hou Xusheng , Zhang Shizhong 

TITLE=Correlation between cerebrospinal fluid abnormalities before ventriculoperitoneal shunt and postoperative intracranial infection in adult patients with hydrocephalus: A clinical study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1023761

DOI=10.3389/fneur.2022.1023761

ISSN=1664-2295

ABSTRACT=Objective: To identify the relationship between preoperative cerebrospinal fluid (CSF) parameters and ventriculoperitoneal shunt infection. Methods: Records of 671 consecutive adult patients who underwent ventriculoperitoneal shunt surgery for the treatment of hydrocephalus at Zhujiang Hospital affiliated with Southern Medical University from January 2011 to March 2022 were reviewed. The patients were divided into infection and non-infection groups based on the presence of postoperative infection. For all patients, we analyzed general clinical data; preoperative CSF parameters ; and postoperative temperature. Results: A total of 397 patients were included, 28 (7.05%) of whom had an infection after the operation and the remaining had no infection. The postoperative infection rate of patients with CSF glucose <2.8 mmol/L  and CSF lactic acid >2.8 mmol/L were significantly higher than that of patients with CSF glucose level≥2.8 mmol/L and CSF lactic acid level in the range of (1-2.8) mmol/L, respectively(p<0.05). Compared with the non-infection group, the level of CSF glucose was significantly lower, and the level of CSF lactic acid was significantly higher in the infection group(p<0.05). Logistic regression analysis showed that preoperative cerebrospinal fluid glucose <2.8 mmol/L (OR=3.911, 95% CI: 1.653~9.253, P=0.002) and cerebrospinal fluid lactate >2.8 mmol/L (OR=4.712, 95% CI: 1.892~11.734, P=0.001) are risk factors for infection after ventriculoperitoneal shunt. ROC analysis revealed that the area under the curve (AUC) for CSF glucose and lactic acid level were 0.602 (95% CI: 0.492-0.713) and 0.818 (95% CI: 0.738-0.898), respectively. The infection group had higher rates of fever and body temperature on postoperative day 3-7 (p<0.05). Conclusions: For adult hydrocephalus patients without clinical manifestations of intracranial infection but only with simple abnormality of cerebrospinal fluid, when the content of glucose in cerebrospinal fluid is less than 2.8 mmol/L, and the content of lactic acid is more than 2.8 mmol/L, it is recommended to perform ventriculoperitoneal shunt after further improvement of cerebrospinal fluid indicators, otherwise, hasty operation will increase the postoperative infection rate. The postoperative fever rate of ventriculoperitoneal shunt surgery is high and the body temperature drops rapidly. If there is still fever after day 3 after surgery, whether there is intracranial infection should be considered.