Cerebrospinal fluid:serum glucose ratio in the ventricular and lumbar compartments: implications for clinical practice

Hegen, Harald; Walde, Janette; Auer, Michael; Deisenhammer, Florian

doi:10.1111/ene.13513

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…Similarly, we found a moderate correlation between CSF and serum glucose values. This is an expected finding, as studies such as Hegen et al demonstrated that CSF glucose is typically about 60% of the serum glucose levels [15]. Of particular interest is why three of the four patients with positive CSF cultures only demonstrated infection in either the ventricular or lumbar cistern, but not both.…”

Section: Discussionmentioning

confidence: 55%

Comparison of Ventricular and Lumbar Cerebrospinal Fluid Composition

Podkovik¹,

Kashyap²,

Wiginton³

et al. 2020

Cureus

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Cerebrospinal fluid (CSF) analysis is a common diagnostic tool used to evaluate diseases of the central nervous system (CNS). We sought to determine whether there is a difference between the composition of CSF sampled from an external ventricular drain (EVD) and lumbar drain (LD) and whether this made a difference in guiding therapeutic decisions. Patients and Methods This study was a retrospective analysis from a single neurosurgery service between the dates of January 2011 and April 2019. A total of 12,134 patients were screened. Inclusion criteria were ages 18-80 and the presence of both an EVD and LD. Exclusion criteria were not having both routes of CSF sampling and the inability to determine which samples originated from which compartment. Results Six patients underwent simultaneous spinal and ventricular routine CSF sampling <24 hours apart and were analyzed for their compositions. There were 42 samples, but only 20 paired EVD-LD samples that could be analyzed. When comparing the EVD and LD sample compositions, there were statistically significant differences in white blood cells (WBCs; p = 0.040), total protein (p = 0.042), and glucose (p = 0.043). Red blood cells (RBCs; p = 0.104) and polymorphonuclear leukocytes (PMN; p = 0.544) were not statistically significant. We found a statistically significant correlation between cranial and spinal CSF WBC (r = 0.944, p < 0.001), protein (r = 0.679, p = 0.001), and glucose (r = 0.805, p < 0.001). We also found that there was a significant correlation between CSF and serum glucose (r = 0.502, p = 0.040). There was no statistically significant correlation between RBCs (r = 0.276, p = 0.252).

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Section: Discussionmentioning

confidence: 55%

Comparison of Ventricular and Lumbar Cerebrospinal Fluid Composition

Podkovik¹,

Kashyap²,

Wiginton³

et al. 2020

Cureus

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“…Also, the comparison between TBI and controls could be somewhat biased considering the location of the CSF collection. Whereas the TBI patients had their CSF samples collected from external ventricular drains, controls had a lumbar puncture for CSF collection, which could affect the composition and content of various purines and their metabolites (Brandner et al, 2013; Hegen et al, 2018; Podkovik et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid purinomics as a biomarker approach to predict outcome after severe traumatic brain injury

Strogulski

Stefani

Böhmer

et al. 2022

Journal of Neurochemistry

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Severe traumatic brain injury (TBI) is associated with high rates of mortality and long‐term disability linked to neurochemical abnormalities. Although purine derivatives play important roles in TBI pathogenesis in preclinical models, little is known about potential changes in purine levels and their implications in human TBI. We assessed cerebrospinal fluid (CSF) levels of purines in severe TBI patients as potential biomarkers that predict mortality and long‐term dysfunction. This was a cross‐sectional study performed in 17 severe TBI patients (Glasgow Coma Scale <8) and 51 controls. Two to 4 h after admission to ICU, patients were submitted to ventricular drainage and CSF collection for quantification of adenine and guanine purine derivatives by HPLC. TBI patients’ survival was followed up to 3 days from admission. A neurofunctional assessment was performed through the modified Rankin Scale (mRS) 2 years after ICU admission. Purine levels were compared between control and TBI patients, and between surviving and non‐surviving patients. Relative to controls, TBI patients presented increased CSF levels of GDP, guanosine, adenosine, inosine, hypoxanthine, and xanthine. Further, GTP, GDP, IMP, and xanthine levels were different between surviving and non‐surviving patients. Among the purines, guanosine was associated with improved mRS (p = 0.042; r = −0.506). Remarkably, GTP displayed predictive value (AUC = 0.841, p = 0.024) for discriminating survival versus non‐survival patients up to 3 days from admission. These results support TBI‐specific purine signatures, suggesting GTP as a promising biomarker of mortality and guanosine as an indicator of long‐term functional disability.

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“…Whereas the TBI patients had their CSF samples collected from external ventricular drains, controls had lumbar puncture for CSF collection, which could affect the composition and content of various metabolites though a specific influence on purines is not known yet (Brandner et al, 2013;Hegen et al, 2018;Podkovik et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid purinomics as a biomarker approach to predict outcome after severe traumatic brain injury

Strogulski

Stefani

Böhmer

et al. 2021

Preprint

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Severe traumatic brain injury (TBI) is associated with high rates of mortality and long-term disability linked to neurochemical abnormalities. Although purine-derivatives play important roles in TBI pathogenesis in preclinical models, little is known about potential changes in purine levels and their implications in human TBI. We assessed cerebrospinal fluid (CSF) levels of purines in severe TBI patients as potential biomarkers that predict mortality and long-term dysfunction. This was a cross-sectional study performed in 17 severe TBI patients (Glasgow Coma Scale < 8) and 51 controls. Two to four hours after admission to ICU, patients were submitted to ventricular drainage, and CSF collection for quantification of adenine and guanine purine-derivatives by HPLC. TBI patients survival was followed up to 3 days from admission. A neurofunctional assessment was performed through modified Rankin Scale (mRS) two years after ICU admission. Purine levels were compared between control and TBI patients, and between surviving and non-surviving patients. Relative to controls, TBI patients presented increased CSF levels of GDP, guanosine, adenosine, inosine, hypoxanthine, and xanthine. Further, GTP, GDP, IMP, and xanthine levels were different between surviving and non-surviving patients. Among the purines, guanosine was associated with improved mRS (p=0.042; r= -0.506). Remarkably, GTP displayed predictive value (AUC=0.841, p=0.024) for discriminating survival vs. non-survival patients up to three days from admission. These results support TBI-specific purine signatures, suggesting GTP as a promising biomarker of mortality, and guanosine as an indicator of long-term functional disability.

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Cerebrospinal fluid:serum glucose ratio in the ventricular and lumbar compartments: implications for clinical practice

Abstract: The CSF:S ratio was similar in the ventricular and lumbar compartments, and depended mainly on time to laboratory processing and absolute serum glucose levels. Previously established lower limits for CSF:S ratio in lumbar CSF can be also applied for ventricular CSF.

Cited by 13 publications

References 21 publications

Comparison of Ventricular and Lumbar Cerebrospinal Fluid Composition

Comparison of Ventricular and Lumbar Cerebrospinal Fluid Composition

Cerebrospinal fluid purinomics as a biomarker approach to predict outcome after severe traumatic brain injury

Cerebrospinal fluid purinomics as a biomarker approach to predict outcome after severe traumatic brain injury

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