Capillary glucose meters cannot substitute serum glucose measurement to determine the cerebrospinal fluid to blood glucose ratio

Asmolov, Romain; Rousseau, Geoffroy; Grammatico‐Guillon, Leslie; Guillon, Antoine

doi:10.1097/eja.0000000000000677

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…Studies comparing both methods are scarce, limited mainly to the context of type 1 or 2 diabetes mellitus and other pathologies such as shock or poisoning, which do not require great precision in measurements, and yet, even in these studies, cautious interpretation of results is advised. A study in adults previously reported similar results and conclusions concerning the diagnosis of hypoglycorrhachia as this study does; it lacks, however evidence about the performance of the test, also its results show a low degree of agreement [6]. In pediatric population this is the first study, to our knowledge, comparing the performance of venous glucose and glucometry for the diagnosis of hypoglycorrhachia.…”

Section: Discussionsupporting

confidence: 49%

“…In bacterial meningitis, for instance, hypoglycorrhachia is a key finding, which has been explained by the increased use of glucose at brain level, besides a decrease in its transport to the CSF [6], and this alteration can remain present even in the first 48 h of antibiotic use [7]. CSF glucose is proportionally related to blood glucose, yet this relationship is only maintained up to 500 mg/dL of the latter; above this value it has been observed that they lose their linear relationship [8].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the normal value of the CSF glucose/blood glucose ratio is higher or equal to 0.6 [3]. From this limit, multiple cut-off points have been identified in different diseases, as in bacterial meningitis, in which a value of 0.36 or less is highly sensitive and specific (up to 93%) [6,12]. In other diseases, such as glucose transporter 1 (GLUT1) deficiency, the value for definitive diagnosis is <0.4 [2].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic yield of capillary compared to venous glucose in the diagnosis of hypoglycorrhachia in children: A prospective, observational study

Farfán-Albarracín

Ramírez-Sierra

Segura

et al. 2021

Brain and Development

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Introduction: The ratio of cerebrospinal fluid (CSF) glucose and blood glucose is of major relevance, conducting to the diagnosis of hypoglycorrhachia, which is a sign of neuroinfection, as well as a number of neurological diseases of genetic or neoplastic etiology. Glucose in capillary sample (glucometry) is a low cost, readily available technique, as compared to venous glucose. This study aims to compare glucometry to venous glucose in the diagnosis of hypoglycorrhachia in pediatric population. Methods: Prospective cross-sectional study based on data obtained from lumbar punctures in the period from February 2017 to January 2019 in a specialized pediatric institution in Colombia. Results: 97 patients were analyzed, aged 1 month to 17 years old, mean 7.67 years, 52 (53.61%) were female. 26 (26.8%) were diagnosed with hypoglycorrhachia. Pearson correlation coefficient for absolute venous and capillary glucose was 0.54, and 0.55 for the ratios of CSF glucose/venous glucose and CSF glucose/glucometry, which support a linear correlation between the variables in both, absolute values and ratios. Intraclass correlation coefficient was calculated for both, the venous glucose and glucometry ratios, which was 0.52, revealing a moderate agreement among the tests. Sensitivity and specificity of CSF glucose/glucometry, as compared to gold standard are 73.1% and 60.6% respectively; whereas predictive positive value (PPV) and negative predictive value (NPV), were 40.4% and 86.0%. Conclusion: Glucometry cannot replace the glucose in venous sample in the diagnosis of hypoglycorrhachia in children.

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Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic yield of capillary compared to venous glucose in the diagnosis of hypoglycorrhachia in children: A prospective, observational study

Farfán-Albarracín

Ramírez-Sierra

Segura

et al. 2021

Brain and Development

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“…As measurements of blood-glucose by blood-gas-analyzers is part of the routine for nearly any ICU-patient a pair of CSF-and blood-glucose is easily generated. This is important since CSF-glucose on its own has a rather poor while a low ratio of CSF-to-blood-glucose of <0.4 has a well-established predictive value for detecting a non-viral meningitis [19]. Importantly however and in contrast to the CSF-lactate-measurements we did not control for the accuracy of the blood-gasanalyzer derived CSF-glucose-measurements by comparing them to results generated by an established CSF-glucose-analyzer.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care Detection of Lactate in Cerebrospinal Fluid

Stephani

Choi

Mörer

2021

Preprint

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Purpose: Measurements of cerebrospinal fluid (CSF)-lactate can aid in detecting infections of the central nervous system and surrounding structures. Neurosurgical patients with temporary lumbar or ventricular CSF-drainage harbor an increased risk for developing infections of the central nervous system which require immediate therapeutic responses. Since blood-gas-analyzers enable rapid blood-lactate-measurements we were interested to find out if CSF-lactate may be reliably measured by this point-of-care technique. Methods: Neurosurgical patients on our intensive care unit (ICU) with either lumbar or external ventricular drainage due to a variety of reasons were included in this prospective observational study. Standard of care included measurements of leucocyte counts, total protein and lactate measurements in CSF by the neurochemical laboratory of our University Medical Center twice a week. With respect to this study we additionally performed nearly daily measurements of cerebrospinal-fluid by blood gas analyzers to determine the reliability of CSF-lactate measured by blood-gas-analyzers as compared to the standard measurements with a certified device. Results: 62 patients were included in this study. 514 CSF measurements were performed with blood-gas-analyzers. 180 of these could be compared to the in-house standard CSF-lactate measurements. Both techniques correlated highly significant (Pearson correlation index 0.94) even though lacking full concordance in a Bland-Altman-plotting. Of particular importance, regular measurements enabled immediate detection of central infection in 3 patients who had developed meningitis during the course of their treatment.Conclusion: CSF-lactate was reliably measured by blood-gas-analyzers and detected developing meningitis timely. In addition to and triggering established CSF-diagnostics, CSF-lactate measurements by blood-gas-analyzers may improve surveillance of central nervous infections in patients with CSF-drainage. This study was retrospectively registered on April 20th 2020 in the German trial register. The trial registration number is: DRKS00021466.

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“…Unfortunately, a paired blood glucose is often not sent contemporaneously and a CSF glucose without a paired blood sample has a poor sensitivity for identifying patients with acute bacterial meningitis. 5 6 As CSF lactate is independent of blood lactate, it does not require paired blood sampling. 2…”

Section: Intracranial Infectionmentioning

confidence: 99%

CSF lactate

et al. 2020

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Lactate is produced from anaerobic glycolysis, which occurs in most tissues in the human body. Blood lactate is tested in most physiologically unwell patients in the Emergency Department and helps to guide treatment and prognosis. Cerebrospinal fluid (CSF) lactate, however, is not often measured. Various central nervous system (CNS) conditions lead to a rise in CSF lactate, including acute neurological infection, stroke, seizures and mitochondrial pathologies. This article discusses the utility and limitations of CSF lactate, highlighting specific clinical situations where it can help in the diagnosis of CNS infections and unexplained encephalopathy.

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Capillary glucose meters cannot substitute serum glucose measurement to determine the cerebrospinal fluid to blood glucose ratio

Cited by 7 publications

References 4 publications

Diagnostic yield of capillary compared to venous glucose in the diagnosis of hypoglycorrhachia in children: A prospective, observational study

Diagnostic yield of capillary compared to venous glucose in the diagnosis of hypoglycorrhachia in children: A prospective, observational study

Point-of-care Detection of Lactate in Cerebrospinal Fluid

CSF lactate

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