Journal
AMERICAN JOURNAL OF MEDICINE
Volume 116, Issue 5, Pages 318-324Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2003.10.027
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Funding
- NIGMS NIH HHS [R01 GM061655-01A2, GM58273, GM061655, R01 GM058273-04] Funding Source: Medline
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PURPOSE: Other than age, the risk factors for postherpetic neuralgia are not well established. We studied whether the concentration of interleukin 8 in the cerebrospinal fluid is associated with the risk of postherpetic neuralgia. METHODS: We enrolled 170 patients more than 50 years old who had a typical painful and nontrigeminal herpetic rash. Patients were treated with acyclovir; no corticosteroids were given. Cerebrospinal fluid was taken for analysis of interleukin 8 during and at full crusting of the herpetic rash. Age, sex, comorbid conditions, prodromal pain, localization and severity of herpetic rash, number of skin lesions, and degree of pain were recorded. We used multivariate logistic regression modeling to identify significant predictive factors. Receiver operating characteristic (ROC) curves were evaluated to determine the contribution of each factor. RESULTS: Six months after healing, 31 patients (18%) had postherpetic neuralgia; 27 patients still had it after 1 year. Only three variables-age (odds ratio [OR] = 2.7 per 10-year increase; 95% confidence interval [Cl]: 1.2 to 6.2), acute pain (OR = 1.8 per unit increase in visual analog scale; 95% CI: 1.2 to 2.8), and interleukin 8 concentration in the cerebrospinal fluid at full crusting of the herpetic rash (OR = 1.6 per 20-mug/L increase; 95% Cl: 1.3 to 2.0)-were significant predictors of postherpetic neuralgia at I year. Interleukin 8 concentration also had the highest area under the ROC curve at these evaluation points (P <0.001). CONCLUSION: Our results suggest that interleukin 8 concentration in the cerebrospinal fluid at full crusting of herpetic rash may be useful for identifying patients who are likely to develop intractable postherpetic neuralgia. (C) 2004 by Excerpta Medica Inc.
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