Elevated cerebrospinal fluid protein predicts lumbar drainage catheter occlusion in neurosurgical patients

Lumbar drainage (LD) is essential in neurosurgery, but catheter occlusion remains a common complication impairing treatment effectiveness. While cerebrospinal fluid (CSF) composition has been associated with occlusion, the predictive value of individual parameters requires clarification. This study aimed to evaluate the predictive value of CSF composition, particularly protein levels, in the development of catheter occlusion. This single-center, retrospective cohort study included consecutive patients who underwent lumbar drainage catheter placement at West China Hospital during the study period. Patients were followed until catheter removal. Catheter occlusion was defined as persistent drainage < 50 mL/day or abrupt cessation. Univariate and multivariate logistic regression analyses were conducted to identify predictors of occlusion. Receiver operating characteristic (ROC) curve analysis was used to assess predictive performance and determine optimal thresholds. Among 293 patients, 43 (14.7%) experienced catheter occlusion. The median CSF protein level was significantly higher in the occlusion group (9.48 g/L [IQR: 6.22-14.35]) than in the non-occlusion group (1.61 g/L [IQR: 1.05-2.64]) (p < 0.001). CSF cell count was also elevated in the occlusion group (360 × 10⁶/L [IQR: 100-1350]) relative to the non-occlusion group (27 × 10⁶/L [IQR: 10-200]); however, its discriminative capacity was inferior. CSF protein demonstrated high predictive performance, with an area under the ROC curve (AUC) of 0.935. CSF protein level remained an independent predictor of occlusion in multivariate analysis (OR: 1.933; 95% CI: 1.543-2.421). The optimal protein threshold was 4.265 g/L. When stratified according to protein levels, the incidence of occlusion increased Markedly across groups: 3.3% in the low-protein group (≤ 4.2 g/L), 50.0% in the medium group (4.2-10 g/L), and 100% in the high-protein group (> 10 g/L) (p < 0.001). CSF protein is an independent predictor of lumbar drainage catheter occlusion with excellent discriminatory ability. A CSF protein level exceeding 4.2 g/L should be considered a clinical warning threshold. Early detection and timely intervention may help reduce occlusion-related complications and improve patient outcomes.Clinical trial number: Not applicable.