Zhang Y, Xiao X, Zhang J, Gao Z, Ji N, Zhang L. Diagnostic
accuracy of routine blood examinations and CSF lactate level for
post-neurosurgical bacterial meningitis. Int J Infect Dis. 2017 Apr 6. pii:
S1201-9712(17)30111-X. doi:10.1016/j.ijid.2017.03.026. [Epub ahead of print]
Abstract
OBJECTIVE:
To evaluate the diagnostic accuracy of routine blood
examinations and Cerebrospinal Fluid (CSF) lactate level for Post-neurosurgical
Bacterial Meningitis (PBM) at a large sample-size post-neurosurgical patients.
METHODS:
The diagnostic accuracies of routine blood examinations and
CSF lactate level to distinguish between PAM and PBM were evaluated with the
values of the Area Under the Curve of the Receiver Operating Characteristic
(AUC-ROC) by retrospectively analyzing the datasets of post-neurosurgical
patients in the clinical information databases.
RESULTS:
The diagnostic accuracy of routine blood examinations was
relatively low (AUC-ROC <0.7). The CSF lactate level achieved rather high
diagnostic accuracy (AUC-ROC=0.891; CI 95%, 0.852-0.922). The variables of
patient age, operation duration, surgical diagnosis and postoperative days (the
interval days between the neurosurgery and examinations) were shown to affect
the diagnostic accuracy of these examinations. The variables were integrated
with routine blood examinations and CSF lactate level by Fisher discriminant
analysis to improve their diagnostic accuracy. As a result, the diagnostic
accuracy of blood examinations and CSF lactate level was significantly improved
with an AUC-ROC value=0.760 (CI 95%, 0.737-0.782) and 0.921 (CI 95%, 0.887-0.948)
respectively.
CONCLUSIONS:
The PBM diagnostic accuracy of routine blood examinations
was relatively low, whereas the accuracy of CSF lactate level was high. Some
variables, that are involved in the incidence of PBM, can also affect the
diagnostic accuracy for PBM. Taking into account of the effects of these
variables significantly improve the diagnostic accuracies of routine blood
examinations and CSF lactate level.
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From the manuscript
The value of CSF examinations, such as measurements of the
cell counts, protein concentration and glucose levels, is limited, especially
in distinguishing PBM from Post-neurosurgical Aseptic Meningitis (PAM). PAM is triggered by an aseptic inflammatory
response to hemolysis products, tumor antigens , bone dust and implants, which
are usually produced during neurosurgery…
Although several studies have reported that the blood WBC counts are significantly higher in PBM
than in PAM patients, the actual diagnostic accuracy for PBM of blood WBC
counts and other routine blood examinations has not be comprehensively
evaluated…
CSF lactate originates from anaerobic glycolysis inside
bacteria and ischemic brain tissue caused by bacterial infection. The CSF
lactate level reportedly is a good marker to distinguish bacterial meningitis
from aseptic meningitis…
A total of 8524 patients were operated at the period. More
than 3 million datasets from the three databases were extracted and matched to
exclude redundancy and incompleteness…
The routine CSF examination was considered positive when it
met both of the following criteria: 1) CSF WBC count ≥ 1000/L [should be >
1000/microliter]and polykaryocyte percentage ≥ 75%, and 2) CSF glucose <2.5 mmol/L or ratio of CSF glucose to blood glucose ><0.4…
CSF bacterial culture has been reported to remain negative
in up to 70% of suspected clinical cases , and its positive detection rate has
been as low as 6-8% in our center…
The routine blood examinations include the WBC counts
(bWBC), neutrophil proportion (bNeuT%), platelet counts (bPLT) and sodium concentration
(bNa). Supplemental Table 1 shows that the levels of these examinations
significantly differed between PBM and PAM…
Among these blood examinations, the bPLT and bNa performed
slightly better than bWBC and bNeuT%...
Similar to the findings of previous studies, CSF lactate
level could accurately distinguish PAM from PBM, with an AUC-ROC value of 0.891
(CI 95%, 0.852-0.922); this value was much higher than those blood
examinations.
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