Cerebrospinal Fluid Lactate and Pyruvate Concentrations and Their Ratio in Children: Age-related Reference Intervals

Abstract

Background: Lactate (L) and pyruvate (P) concentrations in cerebrospinal fluid (CSF) and the L/P ratio have diagnostic value in numerous primary and acquired disorders affecting the central nervous system, but agerelated reference values are not available for children. Methods: We analyzed CSF and blood lactate and pyruvate concentrations and their ratio in a 4-year retrospective survey of a children's hospital laboratory database. Reference intervals (10th-90th percentiles) were established from data on 197 hospitalized children. A recent regression modeling method was used to normalize and smooth values against age. The model equation of best fit was calculated for each variable. Results: Slight age-related variations were shown by the model, with an increase in lactate, a decrease in pyruvate, and a resulting increase in the L/P ratio with increasing age. However, the SD did not vary with age. We defined the upper limit of the reference intervals as the 90th percentiles, which from birth to 186 months of age varied continuously from 1.78 to 1.88 mmol/L (6%), 148 to 139 mol/L (6%), and 16.9 to 19.2 (14%) for lactate, pyruvate, and the L/P ratio, respectively. At a threshold of 2 (in Z-score units), the sensitivity for a subgroup of inborn errors of metabolism (respiratory chain disorders) was 73%, 42%, and 31% for lactate, pyruvate, and the L/P ratio, respectively. Conclusions: In children, CSF lactate and pyruvate concentrations and their ratio appear to vary slightly with age. Average 90th percentile values of 1.8 mmol/L, 147 mol/L, and 17, respectively, could be used in

Cerebrospinal Fluid Glucose and Lactate: Age-Specific Reference Values and Implications for Clinical Practice

“…We found a clear age-dependent pattern for CSF lactate. A slight variation with age of the CSF lactate has been described before in a study of children aged 0–15 years [26], with 95 th percentile values around 1.95 mmol/L. Higher 95 th percentiles for children under the age of 6 months were found in the present study (2.01–2.64 mmol/L).…”

Cerebrospinal fluid lactate: measurement of an adult reference interval

“…The CSF lactate reference interval of 1.0-2.2 mmol/L derived in this study is comparable to that observed in previous reports [11][12][13][14] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 More work is required to accurately determine the degree of age-dependent bias on larger data sets in which relevant pathology has been excluded.…”

Cerebrospinal fluid lactate and pyruvate concentrations and ratio in healthy adult dogs

“…In human beings, some studies support that CSF pyruvate decreases and lactate and L/P ratio increase with age (Benoist and others 2003, Wilhelmina and others 2012). However, in one recent study, a positive correlation has been described between the CSF pyruvate concentration and age (Zhang and Natowicz 2012).…”

“…Alterations in CSF levels of different neurotransmitters, enzymes and neuronal metabolic substrates have been found in different diseases affecting the CNS in dogs and cats (Di Terlizzi and Platt 2006). CSF lactate, pyruvate and lactate/pyruvate ratio (L/P ratio) have been proposed as biomarkers of brain energy metabolism (BEM) in humans (Parnetti and others 2000, Benoist and others 2003, Djukic and others 2012) and dogs (Sugi and others 1975, Pugliese and others 2005). Changes in concentration of these metabolites have been observed when oxidative damage, brain hypoxia or mitochondrial damage is present (Sugi and others 1975, Benoist and others 2003, Pugliese and others 2005).…”