Study of the spectrum of microorganisms and determination of the clinical value of cerebrospinal fluid Interleukin-6 and presepsin quantitation in patients with meningoencephalitis after neurosurgical head injury

Neuroinflammation is a most severe head trauma complication, so that assessing a relation between cerebrospinal fluid (CSF) markers and bacterial infection becomes a pressing issue. The study was aimed at analyzing etiologic pattern and evaluate clinical utility of CSF inflammatory markers in patients with meningoencephalitis after neurosurgical head injury (NHI), admitted to the Reanimation unit at the Burdenko Main Military Clinical Hospital in 2023–2024. Two groups were formed: first group (1G) included 23 patients with meningoencephalitis after NHI and negative CSF cultures, second group (2G) included 32 patients with meningoencephalitis after NHI and positive CSF cultures. The control group (CG) consisted of 12 trauma patients with no signs of CNS infection. Spectrum of microorganisms in the CSF and median levels of leukocytes, protein, cytosis, IL-6, and presepsin (PSP) were studied. Threshold levels for cytosis, IL-6, and PSP were calculated while comparing these groups. The results of the analysis on CSF microbial spectrum in 2G patients indicate infection with clinically significant (mainly K. pneumoniae, A. baumannii and coagulase-negative staphylococci (CoNS)) flora. Significant differences in the CSF of patients in 1G and 2G compared to the CG were obtained in the number of leukocytes, protein, cytosis, IL-6, and PSP. The threshold of clinical decision of parameters in CSF in the 1G in relation to the CG: for cytosis - 69 cells / mcl, for IL-6 - 587.1 pg / ml, for the PSP - 546.0 pg / ml. Reliable differences in CSF in patients of the 1G and 2G between the values ​​​​of cytosis, IL-6, PSP were established. Threshold values ​​​​are proposed for the 2G vs. CG and for the 2G vs. 1G: cytosis - 1546.0 and 826.6 cells / mcl, IL-6 levels - 4241.5 and 3672.5 pg / ml, PSP - 1027.5 and 1219.0 pg / ml, respectively. Reliable threshold values for IL-6 and PSP in CSF were obtained, which can be used as additional markers for diagnosis of bacterial complications in patients with meningoencephalitis after NHI.