β‐Trace Protein Test: New Guidelines for the Reliable Diagnosis of Cerebrospinal Fluid Fistula

Meço, Cem; Oberascher, G; Arrer, Erich; Moser, Gerhard; Albegger, Klaus

doi:10.1016/s0194-59980301448-7

Cited by 14 publications

(9 citation statements)

References 19 publications

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“…The main limitations of this study result from patients with renal alteration or bacterial meningitis. In the first case, β‐TP blood concentration is increased with end‐stage renal disease but β‐TP concentration in NS is much lower than that described in blood 23 . Moreover, patients with kidney disease were excluded.…”

Section: Discussionmentioning

confidence: 94%

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Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Almela,

Navarro‐Zaragoza,

Laorden

et al. 2023

Laryngoscope Investig Oto

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ObjectiveTo find an adequate cut‐off point for beta trace protein (β‐TP) in nasal secretion (NS) and validate this diagnostic test with a large sample of patients. Likewise, we evaluated β‐TP test efficacy to confirm the cerebrospinal fluid (CSF) leakage closure after treatment.MethodsWe performed a retrospective analysis with 207 samples from 162 patients with suspected CSF leakage received in the Hospital Universitario Virgen de la Arrixaca between 2010 and 2016. Twenty‐five samples were included in the control group. Samples were obtained from NS through a swab to determine β‐TP using a nephelometry‐based assay. Sensitivity, specificity, and area under the curve (AUC) for β‐TP in NS were assessed using the receiver operator characteristic (ROC) analysis.ResultsUsing imaging techniques, the diagnosis of CSF leak was confirmed in 57 patients (35.19%), while 105 had a negative diagnosis (64.81%). Patients with CSF leakage had significantly higher β‐TP values in NS (16.07 ± 16.94 mg/L, p < .001) than the control group (0.33 ± 0.12 mg/L) and patients without CSF leakage (0.61 ± 2.34 mg/L). Applying a 1 mg/L cut‐off point resulted in 96.5% sensitivity and 97.1% specificity. Positive and negative predictive values (PPV and NPV) at this cut‐off were 94.9% and 98.6%, respectively. Finally, this cut‐off point yields a test efficacy for CSF leak diagnosis of 97% (95% CI 92.9–98.9).ConclusionOur study has established a 1 mg/L β‐TP concentration in NS as a cut‐off point for CSF leakage diagnosis with high sensibility and specificity. These results suggest that β‐TP analysis could be useful to check CSF leak resolution.Level of Evidence4.

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Section: Discussionmentioning

confidence: 94%

“…In the first case, β-TP blood concentration is increased with end-stage renal disease but β-TP concentration in NS is much lower than that described in blood. 23 Moreover, patients with kidney disease were excluded. In the second case, patients with acute meningitis were excluded from the analysis.…”

Section: Discussionmentioning

confidence: 99%

Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Almela,

Navarro‐Zaragoza,

Laorden

et al. 2023

Laryngoscope Investig Oto

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“…La prevalencia de disfunción neuroendócrina fue de 28.4% con déficit principalmente de LH/FSH y TSH e hiperprolactinemia en 11.8%. 8 Kelly y cols. y Lieberman y cols.…”

Section: Discussionunclassified

Disfunción hipofisaria post traumatismo encefalocraneano

Mariela,

Nicole,

Liz

et al. 2023

Rev. Argent. Neuroc.

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Introducción. El hipopituitarismo debe detectarse precozmente en pacientes con TEC por la alta morbi-mortalidad asociada. Objetivo. Analizar la disfunción hormonal hipofisaria post-TEC y la relación entre su gravedad y las alteraciones hormonales encontradas. Materiales y métodos. Estudio observacional prospectivo, 101 pacientes internados en los servicios de Neurocirugía y Terapia Intensiva del Hospital “Ángel C. Padilla” de San Miguel de Tucumán, Argentina, entre el 1 de mayo y el 30 de junio de 2021. Se registraron datos demográficos, escala de Glasgow, tipo de TEC, lesiones asociadas, dosajes de hormonas hipotálamo-hipofisarias y natremia en los primeros siete días post-TEC. Resultados. Incluidos 83 hombres y 18 mujeres con predominante afectación entre los 20-29 años (36,6%). El TEC leve afectó a 7,9%, el TEC moderado a 59,4% y el TEC grave a 32,7%. La lesión estructural descripta con mayor frecuencia fue la contusión (43,6%). El 83,2% del total de los pacientes tenían un dosaje de corticotropina normal, mientras que en el 11,9% fue bajo; el 43,5% de los pacientes registraron cortisol alto y en el 10% de los casos fue bajo. La testosterona se vio disminuida en un 42,6% y el resto de las hormonas del eje no tuvieron cambios significativos. La ACTH fue baja en el 11,9% de los traumas graves con una hipernatremia del 22%. Conclusión. Existe relación entre la gravedad del TEC y la disfunción hipofisaria, estando el trauma grave asociado a déficit hormonal de ACTH e hipernatremia. Palabras Clave: disfunción hipofisaria; escala de coma de Glasgow; hipopituitarismo; trauma de cráneo.

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“…Many researchers, due to its accessibility, have pondered diagnosing CSF fistulas through glucose testing of the draining fluid [4][5][6]. However, this approach is limited by its low sensitivity, and it may not be the most accurate method for diagnosing CSF leakage [7,8]. An alternative and more reliable diagnostic strategy entails evaluating the presence of beta-trace protein or beta-2-transferrin, proteins specifically found in CSF [7,8].…”

Section: Discussionmentioning

confidence: 99%

Fluid Leak From the Spinal-Epidural Puncture Site: Is That Cerebrospinal Fluid?

Torres,

Sa,

Cruz

et al. 2023

Cureus

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We present the case of a 30-year-old parturient who underwent a combined spinal-epidural for an elective cesarean section and subsequently experienced fluid leakage at the puncture site. The fluid analysis indicated a glucose level of 57 mg/dL, which initially raised suspicion of a cerebrospinal fluid fistula. However, an MRI revealed no significant abnormalities, and the patient remained asymptomatic. We aim to highlight that various fluids can emerge from a neuraxial puncture site, including cerebrospinal fluid, interstitial fluid due to edema, or residual local anesthetic. While glucose measurement has been used for diagnosing cerebrospinal fluid leakage, its reliability is questionable. More dependable diagnostic tests can be used such as the measurement of beta-trace protein or beta-2-transferrin or MRI.

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β‐Trace Protein Test: New Guidelines for the Reliable Diagnosis of Cerebrospinal Fluid Fistula

Cited by 14 publications

References 19 publications

Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Cut‐off value for β‐trace protein (β‐TP) as a rapid diagnostic of cerebrospinal fluid (CSF) leak detection

Disfunción hipofisaria post traumatismo encefalocraneano

Fluid Leak From the Spinal-Epidural Puncture Site: Is That Cerebrospinal Fluid?

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