Cureus · 2026
Limited Diagnostic Utility of C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) for Ventriculitis in Adult and Pediatric Traumatic Brain Injury Patients With External Ventricular Drains: A Retrospective Cohort Study.
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Othman Loui, DiGiovanni Alexandra, Khan Yahya, Millar David, Tse Claire, DeRusso Jacqueline, Dias Mark S, Rizk Elias
Аннотация
OBJECTIVE: To evaluate the diagnostic utility of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocyte count in detecting ventriculitis among adult and pediatric patients with traumatic brain injury (TBI) who underwent external ventricular drain (EVD) placement.
METHODS: We performed a retrospective cohort study using the TriNetX Global Collaborative Network. Patients with TBI who underwent EVD placement were stratified by age (≥18 years vs. <18 years) and presence of ventriculitis. Propensity score matching was used to balance demographic and clinical characteristics between cohorts. Laboratory values, including ESR, CRP, leukocyte count, cerebrospinal fluid (CSF) glucose, procalcitonin, and CSF lactate, were compared using median and interquartile range (IQR) as provided by the TriNetX platform.
RESULTS: In adults, leukocyte count, CRP, and ESR demonstrated overlapping distributions between cohorts and did not reliably distinguish ventriculitis. Although CRP reached statistical significance, values showed substantial variability and limited clinical interpretability. In the pediatric cohort, CRP, leukocyte count, and procalcitonin similarly demonstrated overlapping distributions without consistent differentiation between groups. In contrast, CSF glucose was consistently lower in patients with ventriculitis across both adult and pediatric populations. CSF lactate was higher in the adult ventriculitis cohort; however, this finding was based on a limited subset of patients and should be interpreted with caution.
CONCLUSION: Systemic inflammatory markers, including CRP, ESR, and leukocyte count, demonstrated limited diagnostic utility for distinguishing ventriculitis in TBI patients with EVDs. CSF-based markers, particularly CSF glucose, were more consistently associated with ventriculitis, while CSF lactate may have a potential adjunctive role. These findings support prioritizing CSF analysis and pathogen-specific testing for accurate diagnosis. Future studies should focus on prospective validation and the development of more specific biomarkers.
METHODS: We performed a retrospective cohort study using the TriNetX Global Collaborative Network. Patients with TBI who underwent EVD placement were stratified by age (≥18 years vs. <18 years) and presence of ventriculitis. Propensity score matching was used to balance demographic and clinical characteristics between cohorts. Laboratory values, including ESR, CRP, leukocyte count, cerebrospinal fluid (CSF) glucose, procalcitonin, and CSF lactate, were compared using median and interquartile range (IQR) as provided by the TriNetX platform.
RESULTS: In adults, leukocyte count, CRP, and ESR demonstrated overlapping distributions between cohorts and did not reliably distinguish ventriculitis. Although CRP reached statistical significance, values showed substantial variability and limited clinical interpretability. In the pediatric cohort, CRP, leukocyte count, and procalcitonin similarly demonstrated overlapping distributions without consistent differentiation between groups. In contrast, CSF glucose was consistently lower in patients with ventriculitis across both adult and pediatric populations. CSF lactate was higher in the adult ventriculitis cohort; however, this finding was based on a limited subset of patients and should be interpreted with caution.
CONCLUSION: Systemic inflammatory markers, including CRP, ESR, and leukocyte count, demonstrated limited diagnostic utility for distinguishing ventriculitis in TBI patients with EVDs. CSF-based markers, particularly CSF glucose, were more consistently associated with ventriculitis, while CSF lactate may have a potential adjunctive role. These findings support prioritizing CSF analysis and pathogen-specific testing for accurate diagnosis. Future studies should focus on prospective validation and the development of more specific biomarkers.