Study of cerebrospinal fluid levels of lactate, lactate dehydrogenase and adenosine deaminase in the diagnosis and outcome of acute meningitis

Singh, L. K.; Javali, Mahendra; Mehta, Anish; Pradeep, R; Srinivasa, Rangasetty; Acharya, Purushottam

doi:10.1080/01616412.2021.2004366

Cited by 8 publications

(12 citation statements)

References 16 publications

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“…Following this argumentation, CSF lactate is expected to increase with severity of infection, explaining the association with sepsis in bacterial meningitis in our study. Accordingly, CSF lactate has been shown previously to correlate with poorer outcome both in animal models and retrospective patient cohorts, which was also shown in our cohort [ 35 , 36 , 37 ]. In addition to being a mere marker of disease severity, elevated CSF lactate might also directly contribute to it, as N. meningitidis and S. pneumoniae can use lactate as a carbon source in absence of glucose, thus sustaining bacterial growth as CSF glucose levels fall rapidly [ 32 ].…”

Section: Discussionsupporting

confidence: 87%

The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis

et al. 2023

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Community-acquired bacterial meningitis conveys significant morbidity and mortality due to intracranial and systemic complications, and sepsis is a major contributor to the latter. While cerebrospinal fluid (CSF) analysis is essential in the diagnosis of bacterial meningitis, its predictive utility for detection of sepsis is unknown. We investigated the diagnostic performance of CSF parameters for sepsis defined by the Sepsis-3 criteria in a retrospective cohort of patients with community-acquired bacterial meningitis. Among 103 patients, 69.5% developed sepsis. CSF lactate was associated with sepsis with an odds ratio of 1.11 (p = 0.022), while CSF cell counts, glucose and protein levels were not (all p > 0.4). Employing the optimal cutoff of 8.2 mmol/L, elevated CSF lactate resulted in a sensitivity of 81.5% and specificity of 61.5% for sepsis. In exploratory analyses, CSF lactate was also associated with in-hospital mortality with an odds ratio of 1.21 (p = 0.011). Elevated CSF lactate might contribute to early diagnosis of sepsis as well as prognostication in patients with community-acquired bacterial meningitis.

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Section: Discussionsupporting

confidence: 87%

The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis

et al. 2023

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“…CSF lactate level is correlated with the time since onset of cerebral ischemia, which reaches a maximal level at 48 h after onset of cerebral ischemia (36). Previous studies have also demonstrated that CSF lactate level was an independent risk factor for the prognosis in patients with TBM, and the CSF lactate concentration was significantly higher in patients with poor prognosis than those with good prognosis (37)(38)(39). Among the prognostic factors of TBM, previous studies have demonstrated that patients' age and GCS score on admission were prognostic factors in patients with TBM (40)(41)(42)(43)(44).…”

Section: Discussionmentioning

confidence: 97%

“…However, the diagnostic value of CSF ADA test remains to be explored. CSF ADA test results can be interpreted in the context of patients' clinical symptoms and laboratory findings, significantly obviously elevated lactate and ADA levels were suggestive of slower clinical recovery and prolonged hospital stay (39,46). Elevated CSF protein level is one of the main presentations of TBM.…”

Section: Discussionmentioning

confidence: 99%

High cerebrospinal fluid lactate concentration at 48 h of hospital admission predicts poor outcomes in patients with tuberculous meningitis: A multicenter retrospective cohort study

et al. 2022

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ObjectiveThis study aimed to analyze the cerebrospinal fluid (CSF) parameters affecting the outcomes of patients with tuberculous meningitis (TBM).MethodsThis is a multi-center, retrospective, cohort study involving 81 patients who were diagnosed with TBM and treated in Haihe Clinical College of Tianjin Medical University, Tianjin Medical University General Hospital, and General Hospital of Air Force PLA from January 2016 to December 2019. Baseline data, Glasgow Coma Scale (GCS) score, and clinical presentations of all patients were collected at admission. CSF samples were collected at 48 h, 1, 2, and 3 weeks after admission. CSF lactate, adenosine deaminase, chloride, protein, glucose levels and intracranial pressure were measured. After a follow-up of 16.14 ± 3.03 months, all patients were assessed using the modified Rankin Scale (mRS) and divided into good (mRS scores of 0–2 points) and poor outcome groups (mRS scores of 3–6 points). The differences in patients' baseline data, GCS score, clinical presentations, and levels of CSF parameters detected at 48 h, 1, 2, and 3 weeks after admission between two groups were compared. Statistically significant variables were added to the binary logistic regression model to identify the factors impacting the outcomes of patients with TBM. Receiver operating characteristic (ROC) curve was used to assess the predictive ability of the model.ResultsThe CSF lactate level exhibited a decreasing trend within 3 weeks of admission in the two groups. For the within-group comparison, statistically significant differences in the lactate level was found in both groups between four different time points. A binary logistic regression model revealed that CSF lactate level at 48 h after admission, age, and GSC score on admission were independently associated with the outcomes of patients with TBM. ROC curve analysis showed that the area under the ROC curve (AUC) was 0.786 for the CSF lactate level (48 h), 0.814 for GCS score, and 0.764 for age.ConclusionHigh CSF lactate level at 48 h after admission is one of the important factors for poor outcomes in patients with TBM.

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“…CSF lactate is now recognized as a valuable marker for diagnosing acute meningitis. It has shown to be a helpful marker in diagnosing nosocomial meningitis and has shown up to 100% sensitivity for diagnosing bacterial meningitis[ 19 ]. As it is a rapid, inexpensive and readily available tool, it may guide physicians in making an early diagnosis of acute meningitis and differentiating bacterial from other causes of meningitis.…”

Section: Discussionmentioning

confidence: 99%

Role of cerebrospinal fluid lactate in diagnosing meningitis in critically ill patients

Yadav¹,

Singh²,

Juneja³

et al. 2023

World J Crit Care Med

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BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity. Early diagnosis and specific treatment may improve outcomes. Lack of specific clinical signs or tests make the diagnosis challenging. AIM To assess the efficacy of cerebrospinal fluid (CSF) lactate in diagnosing meningitis in critically ill patients. METHODS A prospective, observational cohort study was carried out in a neuro-medical intensive care unit (ICU) over a 22 mo period. Adult patients, with suspected meningitis admitted in ICU, were serially recruited. Patients who refused consent, those with peripheral sensorineural deficit, or with any contraindication to lumber puncture were excluded. CSF cytology, bio-chemistry, lactates, culture and polymerase chain reaction based meningo-encephalitis panel were evaluated. Patients were divided in two groups based on clinical diagnosis of meningitis. The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests. RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis. The mean values of CSF total leucocyte count (TLC), proteins and lactates were significantly higher in meningitis group. There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel. CSF lactate (> 2.72 mmol/L) showed good accuracy in diagnosing meningitis with an area under the curve of 0.81 (95% confidence interval: 0.69-0.93), sensitivity of 82.6%, and specificity 72.9%. These values were comparable to those of CSF TLC and protein. Twelve patients with bacterial meningitis had significantly higher CSF lactate (8.9 ± 4.7 mmol/L) than those with non-bacterial meningitis (4.2 ± 3.8 mmol/L), P = 0.006. CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients. CSF lactate (> 2.72 mmol/L) showed good accuracy, sensitivity, and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.

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Study of cerebrospinal fluid levels of lactate, lactate dehydrogenase and adenosine deaminase in the diagnosis and outcome of acute meningitis

Cited by 8 publications

References 16 publications

The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis

The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis

High cerebrospinal fluid lactate concentration at 48 h of hospital admission predicts poor outcomes in patients with tuberculous meningitis: A multicenter retrospective cohort study

Role of cerebrospinal fluid lactate in diagnosing meningitis in critically ill patients

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