Cerebrospinal Fluid Lactate as an Indicator for Post-Neurosurgical Bacterial Meningitis

Abstract

Objective To evaluate the interest of cerebrospinal fluid (CSF) lactate assay for the diagnosis of post-neurosurgical bacterial meningitis (PBM). Methods We conducted at our neurosurgical resuscitation unit a prospective study of patients who underwent elective or emergency craniotomy. Lumbar puncture was performed in all patients who had clinical suspicion of PBM for CSF culture and cytological and chemical analysis (glucose, protein, lactate). The diagnosis of PBM is made according to the criteria proposed by the Center for Disease Control and Prevention (CDC). Receiver Operating Characteristic (ROC) was used to determine the diagnostic accuracy of CSF lactate. Results 72 patients were studied and only 32 of them had the clinical and biological criteria of the diagnosis of PBM. Median CSF lactate was 6.18 mmol/L for PBM vs 2.63 mmol/L for no PBM (p < 0.001). CSF lactate may predict the presence PBM, with a AUC of 0.98 and NPV of 99.1. The analysis of Youden's index also confirms the good diagnostic power of CSF lactate with a value of 83 at a cut-off value of 4 mmol/L and a sensitivity of 92.3% and specificity of 91.6%. Conclusion Our study shows that the CSF lactate as an indicator for PBM. It is a fast and simple test that can help the clinician to optimize the management of PBM and decrease premature cessation of antibiotics. How to cite this article Lotfi R, Ines B, et al. Cerebrospinal Fluid Lactate as an Indicator for Post-neurosurgical Bacterial Meningitis. Indian J Crit Care Med 2019;23(3):127-130.

Healthcare-Associated Ventriculitis in Children during COVID-19 Pandemic: Clinical Characteristics and Outcome of a First Infection

“…In most of our cases, serum glucose levels were not available at the same moment as the CSF analysis. The CSF lactate value has also been used as a biomarker of infection in neurosurgical patients, with a sensitivity of 92% and a specificity of 88%, cutoff values between 3.4 and 5.4 mmol/L, and a positive likelihood ratio of 7.7 [26][27][28]. In this study, the lowest value was 0.06 mmol/L, but the median was 3.4 mmol/L, so it may be useful in conjunction with other parameters of CSF analysis for the diagnosis of HAV in patients with negative culture, as it is a simple, available test that is not affected by blood contamination of the CSF.…”

CSF lactate

“…A CSF lactate of ≥4 mmol/L in patients with suspected post-neurosurgical bacterial meningitis has a better predictive value than either CSF pleocytosis or hypoglycorrhachia. 8 9…”

Clinical Value of Glycan Changes in Cerebrospinal Fluid for Evaluation of Post-Neurosurgical Bacterial Meningitis with Hemorrhagic Stroke Patients

“…Therefore, biochemical, and immunological components in cerebrospinal fluid (CSF) are often influenced by various confounding factors that may be resulted from both primary neurological disease and surgical procedure. Recent studies have proposed that the procalcitonin (PCT), lactate and neuron-specific enolase in CSF were promising biomarkers for diagnosis of PNBM [5,6]. However, molecular levels can be also influenced by physical and chemical changes of CSF, such as hemolysis, which is a common phenomenon during the procedure of lumbar puncture [7].…”