• M C Asi-Bautista, S M Heidemann, K L Meert, A I Canady, and A P Sarnaik.
• Department of Pediatrics, Children's Hospital of Michigan, Detroit 48201, USA.
• Crit. Care Med. 1997 Oct 1; 25 (10): 1713-6.

ObjectiveTo determine the diagnostic value of cerebrospinal fluid tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, and IL-6 released into the cerebrospinal fluid of patients with ventriculoperitoneal shunt infection.DesignProspective, observational study.SettingUniversity teaching hospital.PatientsSixty-four patients requiring cerebrospinal fluid aspiration for suspected ventriculoperitoneal shunt malfunction.InterventionsCerebrospinal fluid samples were obtained by shunt aspiration at the time of patient presentation.Measurements And Main ResultsTNF-alpha and IL-1 beta concentrations were measured by enzyme-linked immunosorbent assay, and IL-6 activity by bioassay. The sensitivity, specificity, predictive values, and overall efficiency for each cytokine were determined based on the cerebrospinal fluid culture results. Ten patients had positive cerebrospinal fluid cultures, eight of which yielded Staphylococcus species, and one each Acinetobacter and Pseudomonas. Cerebrospinal fluid TNF-alpha, IL-1 beta, IL-6, protein, and leukocyte concentrations were significantly increased in patients with shunt infection. Cerebrospinal fluid IL-6 activity had the highest diagnostic accuracy of the cytokines evaluated, with sensitivity of 80% and specificity of 98%.ConclusionsThe presence of cerebrospinal fluid inflammatory cytokines strongly suggests ventriculoperitoneal shunt infection. Detection of these cytokines in the cerebrospinal fluid could be used for earlier diagnosis of bacterial infection.

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