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Diagnostic Reliability of Cerebral Spinal Fluid Tests for Acute Confusional State (Delirium) in Patients with Systemic Lupus Erythematosus: Interleukin 6 (IL-6), IL-8, Interferon-α, IgG Index, and Q-Albumin YASUHIRO KATSUMATA, MASAYOSHI HARIGAI, YASUSHI KAWAGUCHI, CHIKAKO FUKASAWA, MAKOTO SOEJIMA, KAE TAKAGI, MICHI TANAKA, HISAE ICHIDA, AKIKO TOCHIMOTO, TOKIKO KANNO, KATSUJI NISHIMURA, NAOYUKI KAMATANI, and MASAKO HARA
ABSTRACT. Methods. We performed a prospective study using a cohort of 59 patients with SLE and compared those with and without ACS. Associations between ACS and each CSF test [interleukin 6 (IL-6), IL-8, interferon-a, IgG index, and Q-albumin] were statistically evaluated. Each patient underwent all CSF evaluations. Results. ACS was diagnosed in 10 patients (ACS group), SLE-related CNS syndromes except ACS in 13, and no CNS syndromes in 36 (non-CNS group). CSF IL-6 levels in the ACS group were significantly higher than those in the non-CNS group (p < 0.05). A positive IgG index (p = 0.028) was significantly associated with ACS. No other test showed a significant association with ACS. The positive and negative predictive values for the diagnosis of ACS in SLE were 80% and 85% for elevated CSF IL-6 levels (≥ 31.8 pg/ml), and 75% and 83% for the IgG index, respectively. Conclusion. No single CSF test had sufficient predictive value to diagnose ACS in SLE, although CSF IL-6 levels and the IgG index showed statistical associations with ACS. Use of CSF tests combined with careful history and clinical examinations is recommended for proper diagnosis of ACS in SLE. (First Release Sept 15 2007; J Rheumatol 2007;34:2010-7) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS
From the Institute of Rheumatology and Department of Psychiatry, Tokyo Women's Medical University, Tokyo; and Departments of Pharmacovigilance and Rheumatology and Medicine, Tokyo Medical and Dental University Graduate School, Tokyo, Japan. Supported by a grant from Health and Labour Sciences Research, Japan. Y. Katsumata, MD; Y. Kawaguchi, MD, PhD; C. Fukasawa, MD, PhD; M. Soejima, MD; K. Takagi, MD, PhD; M. Tanaka, MD, PhD; H. Ichida, MD; A. Tochimoto, MD; T. Kanno, MD; N. Kamatani, MD, PhD; M. Hara, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Clinical Research Center and Department of Rheumatology and Medicine, Tokyo Medical and Dental University; K. Nishimura, MD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine. Address reprint requests to Dr. Y. Katsumata, Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo 162-0054, Japan. E-mail: katsumata@ior.twmu.ac.jp Accepted for publication July 4, 2007. |
