Bortcosh William, Siedner Mark, Carroll Ryan W
Massachusetts General Hospital, Boston, MA, USA.
Mbarara University of Science and Technology, Mbarara, Uganda.
Trop Med Int Health. 2017 Sep;22(9):1072-1080. doi: 10.1111/tmi.12913. Epub 2017 Jul 10.
Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource settings (LRS) often lack the capacity to perform these studies. We sought to determine whether the presence of white blood cells in CSF detected by commercially available urine reagent strips could aid in the diagnosis of bacterial meningitis.
We searched PubMed for studies published between 1980 and 2016 that investigated the use of urine reagent strips to identify cerebrospinal fluid (CSF) pleocytosis. We assessed studies in any language that enrolled subjects who underwent lumbar puncture and had cerebrospinal fluid testing by both standard laboratory assays and urine reagent strips. We abstracted true-positive, false-negative, false-positive and true-negative counts for each study using a diagnostic threshold of ≥10 white blood cells per microlitre for suspected bacterial meningitis and performed mixed regression modelling with random effects to estimate pooled diagnostic accuracy across studies.
Our search returned 13 studies including 2235 participants. Urine reagent strips detected CSF pleocytosis with a pooled sensitivity of 92% (95% CI: 84-96), a pooled specificity of 98% (95% CI: 94-99) and a negative predictive value of 99% when the bacterial meningitis prevalence is 10%.
Urine reagent strips could provide a rapid and accurate tool to detect CSF pleocytosis, which, if negative, can be used to exclude diagnosis of bacterial meningitis in settings without laboratory infrastructure. Further investigation of the diagnostic value of using protein, glucose and bacteria components of these strips is warranted.
细菌性脑膜炎的诊断通常需要细胞计数、化学检测和/或微生物培养能力。不幸的是，资源匮乏地区（LRS）的实验室资源往往缺乏开展这些检测的能力。我们试图确定，市售尿液试剂条检测脑脊液（CSF）中白细胞的存在是否有助于细菌性脑膜炎的诊断。
我们在PubMed上搜索了1980年至2016年间发表的研究，这些研究调查了尿液试剂条用于识别脑脊液细胞增多的情况。我们评估了任何语言的研究，这些研究纳入了接受腰椎穿刺并通过标准实验室检测和尿液试剂条进行脑脊液检测的受试者。对于每项研究，我们提取了真阳性、假阴性、假阳性和真阴性计数，将疑似细菌性脑膜炎的诊断阈值设定为每微升≥10个白细胞，并进行了具有随机效应的混合回归建模，以估计各研究的合并诊断准确性。
我们的搜索返回了13项研究，包括2235名参与者。当细菌性脑膜炎患病率为10%时，尿液试剂条检测脑脊液细胞增多的合并敏感性为 92%（95%CI：84-96），合并特异性为98%（95%CI：94-99），阴性预测值为99%。
尿液试剂条可提供一种快速准确的工具来检测脑脊液细胞增多，若检测结果为阴性，则可用于在没有实验室基础设施的情况下排除细菌性脑膜炎的诊断。有必要进一步研究这些试剂条的蛋白质、葡萄糖和细菌成分的诊断价值。
