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Cerebrospinal fluid lactate

The predictive ability of CSF lactate for bacterial meningitis has been examined in two published metaanalysis 1) 2).

It can differentiate bacterial meningitis (> 6 mmol/l), from partially treated meningitis (4 to 6 mmol/l) and aseptic meningitis (< 2 mmol/l) 3) However, other researchers have suggested that CSF lactate offers no additional clinically useful information over conventional CSF markers 4) 5).

In a febrile patient with a ventriculostomy, diagnosing or excluding bacterial or microbial ventriculitis is difficult, as conventional markers in analysis of cerebrospinal fluid (CSF) are not applicable due to presence of blood and inflammation.

Data from a large sample of CSF studies in patients with ventriculostomy indicate that no single value of CSF lactate provided both sensitivity and specificity high enough to be regarded as reliable test 6).

Glutamate and lactate are significantly increased in nonsurvival relative to survival patients. We tested the accuracy of both biomarkers to discriminate patient outcome. Setting a cutoff of >57.75, glutamate provides 80.0% of sensitivity and 84.62% of specificity (AUC: 0.8214, 95% CL: 54.55-98.08%; and a cutoff of >4.65, lactate has 100% of sensitivity and 85.71% of specificity (AUC: 0.8810, 95% CL: 54.55-98.08%). BDNF and GDNF did not discriminate poor outcome 7).

Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K. Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. Crit Care. 2010;14(6):R240. doi: 10.1186/cc9395. Epub 2010 Dec 31. Review. PubMed PMID: 21194480; PubMed Central PMCID: PMC3220013.
Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. J Infect. 2011 Apr;62(4):255-62. doi: 10.1016/j.jinf.2011.02.010. Epub 2011 Mar 5. Review. PubMed PMID: 21382412.
Cunha BA. Distinguishing bacterial from viral meningitis: the critical importance of the CSF lactic acid levels. Intensive Care Med. 2006 Aug;32(8):1272-3; author reply 1274. Epub 2006 Jun 13. Erratum in: Intensive Care Med. 2006 Dec;32(12):2092. PubMed PMID: 16770614.
Gästrin B, Briem H, Rombo L. Rapid diagnosis of meningitis with use of selected clinical data and gas-liquid chromatographic determination of lactate concentration in cerebrospinal fluid. J Infect Dis. 1979 May;139(5):529-33. PubMed PMID: 35573.
Ruuskanen O, Ståhlberg ML, Korvenranta H, Nikoskelainen J, Irjala K. CSF lactate in bacterial meningitis with minimal CSF abnormalities. Acta Paediatr Scand. 1985 Mar;74(2):292-3. PubMed PMID: 3993378.
Hill E, Bleck TP, Singh K, Ouyang B, Busl KM. CSF lactate alone is not a reliable indicator of bacterial ventriculitis in patients with ventriculostomies. Clin Neurol Neurosurg. 2017 Jun;157:95-98. doi: 10.1016/j.clineuro.2017.03.021. Epub 2017 Mar 22. PubMed PMID: 28458153.
Stefani MA, Modkovski R, Hansel G, Zimmer ER, Kopczynski A, Muller AP, Strogulski NR, Rodolphi MS, Carteri RK, Schmidt AP, Oses JP, Smith DH, Portela LV. Elevated glutamate and lactate predict brain death after severe head trauma. Ann Clin Transl Neurol. 2017 May 4;4(6):392-402. doi: 10.1002/acn3.416. eCollection 2017 Jun. PubMed PMID: 28589166; PubMed Central PMCID: PMC5454398.
cerebrospinal_fluid_lactate.txt · Last modified: 2017/06/24 17:00 by administrador