Domingues Renan Barros, Fernandes Gustavo Bruniera Peres, Leite Fernando Brunale Vilela de Moura, Senne Carlos
Senne Líquor Diagnóstico, São Paulo, São Paulo, Brazil.
Rev Inst Med Trop Sao Paulo. 2019 Apr 18;61:e24. doi: 10.1590/S1678-9946201961024.
The cytological and biochemical examination of cerebrospinal fluid (CSF) has been used for the presumed diagnosis of bacterial meningitis until the final microbiological results are achieved. We assessed the ability of CSF lactate in comparison with other CSF parameters to discriminate bacterial and enteroviral community acquired meningitis. We included 1,187 CSF samples of acute community-acquired meningitis, being 662 cases of bacterial and 525 of enteroviral meningitis. Lactate concentration (mg/dL), leukocyte count/mm3, protein (mg/dL), and glucose (mg/dL) were compared between bacterial and viral meningitis. Receiver operator characteristic (ROC) curves were used to assess diagnostic performance. CSF leukocytes, CSF protein and CSF lactate were significantly higher in bacterial meningitis cases (P<0.0001). CSF glucose was significantly lower in bacterial meningitis cases (P<0.0001). CSF lactate showed the best predictive ability with an area under the curve of 0.944 (95% CI 0.929 - 0.959). Considering a cut off of CSF lactate of 30 mg/dL, the sensitivity and specificity for bacterial meningitis were 84.1% and 99%, respectively. In the cytological and biochemical CSF analysis, CSF lactate was the most accurate marker for bacterial meningitis.
在获得最终微生物学结果之前，脑脊液（CSF）的细胞学和生化检查一直被用于细菌性脑膜炎的疑似诊断。我们评估了脑脊液乳酸与其他脑脊液参数相比，在鉴别细菌性和肠道病毒性社区获得性脑膜炎方面的能力。我们纳入了1187份急性社区获得性脑膜炎的脑脊液样本，其中662例为细菌性脑膜炎，525例为肠道病毒性脑膜炎。比较了细菌性脑膜炎和病毒性脑膜炎之间的乳酸浓度（mg/dL）、白细胞计数/mm³、蛋白质（mg/dL）和葡萄糖（mg/dL）。采用受试者工作特征（ROC）曲线评估诊断性能。细菌性脑膜炎病例的脑脊液白细胞、脑脊液蛋白和脑脊液乳酸显著更高（P<0.0001）。细菌性脑膜炎病例的脑脊液葡萄糖显著更低（P<0.0001）。脑脊液乳酸显示出最佳预测能力，曲线下面积为0.944（95%CI 0.929 - 0.959）。考虑脑脊液乳酸截断值为30 mg/dL时，细菌性脑膜炎的敏感性和特异性分别为84.1%和99%。在脑脊液的细胞学和生化分析中，脑脊液乳酸是细菌性脑膜炎最准确的标志物。
