Anne Rajendra P, Dutta Sourabh, Balasubramanian Haribalakrishna, Aggarwal Ashutosh N, Chadha Neelima, Kumar Praveen
Department of Pediatrics, Division of Neonatology, Kasturba Medical College, Manipal, Karnataka, India.
Department of Pediatrics, Neonatology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Am J Perinatol. 2024 May;41(S 01):e1962-e1975. doi: 10.1055/a-2095-6729. Epub 2023 May 17.
Cerebrospinal fluid (CSF) white blood cell (WBC) count, protein, and glucose (cytochemistry) are performed to aid in the diagnosis of meningitis in young infants. However, studies have reported varying diagnostic accuracies. We assessed the diagnostic accuracy of CSF cytochemistry in infants below 90 days and determined the certainty of evidence.
We searched PubMed, Embase, Cochrane Library, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases in August 2021. We included studies that evaluated the diagnostic accuracy of CSF cytochemistry compared with CSF culture, Gram stain, or polymerase chain reaction in neonates and young infants <90 days with suspected meningitis. We pooled data using the hierarchical summary receiver operator characteristic (ROC) model.
Of the 10,720 unique records, 16 studies were eligible for meta-analysis, with a cumulative sample size of 31,695 (15 studies) for WBC, 12,936 (11 studies) for protein, and 1,120 (4 studies) for glucose. The median (Q, Q) specificities of WBC, protein, and glucose were 87 (82, 91), 89 (81, 94), and 91% (76, 99), respectively. The pooled sensitivities (95% confidence interval [CI]) at median specificity of WBC count, protein, and glucose were 90 (88, 92), 92 (89, 94), and 71% (54, 85), respectively. The area (95% CI) under ROC curves were 0.89 (0.87, 0.90), 0.87 (0.85, 0.88), and 0.81 (0.74, 0.88) for WBC, protein, and glucose, respectively. There was an unclear/high risk of bias and applicability concern in most studies. Overall certainty of the evidence was moderate. A bivariate model-based analysis to estimate the diagnostic accuracy at specific thresholds could not be conducted due to a paucity of data.
CSF WBC and protein have good diagnostic accuracy for the diagnosis of meningitis in infants below 90 days of age. CSF glucose has good specificity but poor sensitivity. However, we could not identify enough studies to define an optimal threshold for the positivity of these tests.
· Median specificity of CSF leucocyte count, protein and glucose are similar in young infants.. · At median specificity, CSF leukocyte count and protein are more sensitive than glucose.. · Owing to inadequate data, bivariate modelling to suggest optimal diagnostic thresholds is not possible..
进行脑脊液（CSF）白细胞（WBC）计数、蛋白质和葡萄糖（细胞化学）检测以辅助诊断幼儿脑膜炎。然而，研究报告的诊断准确性各不相同。我们评估了脑脊液细胞化学对90日龄以下婴儿脑膜炎的诊断准确性，并确定了证据的确定性。
我们于2021年8月检索了PubMed、Embase、Cochrane图书馆、Ovid、护理及相关健康文献累积索引（CINAHL）和Scopus数据库。我们纳入了评估脑脊液细胞化学与脑脊液培养、革兰氏染色或聚合酶链反应相比，对疑似脑膜炎的新生儿和90日龄以下幼儿的诊断准确性的研究。我们使用分层汇总接受者操作特征（ROC）模型汇总数据。
在10720条独特记录中，16项研究符合荟萃分析条件，白细胞计数的累积样本量为31695例（15项研究），蛋白质为12936例（11项研究），葡萄糖为1120例（4项研究）。白细胞、蛋白质和葡萄糖的中位数（Q1，Q3）特异性分别为87%（82%，91%）、89%（81%，94%）和91%（76%，99%）。白细胞计数、蛋白质和葡萄糖在中位数特异性时的汇总敏感性（95%置信区间[CI]）分别为90%（88%，92%）、92%（89%，94%）和71%（54%，85%）。白细胞、蛋白质和葡萄糖的ROC曲线下面积（95%CI）分别为0.89（0.87，0.90）、0.87（0.85，0.88）和0.81（0.74，0.88）。大多数研究存在不明确/高偏倚风险和适用性问题。证据的总体确定性为中等。由于数据不足，无法进行基于双变量模型的分析来估计特定阈值下的诊断准确性。
脑脊液白细胞和蛋白质对90日龄以下婴儿脑膜炎的诊断具有良好的准确性。脑脊液葡萄糖具有良好的特异性但敏感性较差。然而，我们未能找到足够的研究来确定这些检测阳性的最佳阈值。
· 幼儿脑脊液白细胞计数、蛋白质和葡萄糖的中位数特异性相似。· 在中位数特异性时，脑脊液白细胞计数和蛋白质比葡萄糖更敏感。· 由于数据不足，无法进行双变量建模以提出最佳诊断阈值。
