The Diagnostic Dilemma of Traumatic Lumbar Puncture: Current Standing of Cerebrospinal Fluid Leukocyte Corrections and Our Experience With Cerebrospinal Fluid Biomarkers
| Autor: | Qazi Iqbal Ahmad, Mudasir Nazir, Javeed Iqbal Bhat, Ikhlas Ahmad, Muzaffar Ahmad Malik, Syed Wajid Ali, Rais Ahmad Bhat, Wasim A. Wani, Naseer Yousuf Mir, Bashir Ahmad Charoo, Sheeraz A. Dar, Khalid Kawoosa |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Traumatic lumbar puncture Diagnostic dilemma Spinal Puncture Procalcitonin Meningitis Bacterial Diagnosis Differential Leukocyte Count 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid 030225 pediatrics medicine Humans Lactic Acid Prospective Studies 030212 general & internal medicine business.industry Infant Newborn Infant medicine.disease ROC Curve Anesthesia Pediatrics Perinatology and Child Health Female Bacterial meningitis Neurology (clinical) Serum lactate Current (fluid) business Meningitis Biomarkers |
| Zdroj: | Journal of Child Neurology. 33:441-448 |
| ISSN: | 1708-8283 0883-0738 |
| Popis: | Objective: To assess the diagnostic efficiency of cerebrospinal fluid markers of procalcitonin, lactate, and cerebrospinal fluid/serum lactate ratio for detecting bacterial meningitis during traumatic lumbar puncture, and to compare these markers with routinely used uncorrected and corrected leukocyte measurements. Methods: Infants aged ≤90 days with traumatic lumbar puncture were prospectively studied. The diagnostic characteristics of cerebrospinal fluid assays of uncorrected and corrected leukocyte count, procalcitonin, lactate, and lactate ratio were described and compared. Results: Considering the area under the curve (95% CI) analysis and standard cutoff values, the lactate-ratio (0.985 [0.964-0.989] at cutoff 1.2) had the best test indexes for identifying meningitis, followed by lactate (0.964 [0.945-0.984] at cutoff 2.2 mmol/L) and procalcitonin (0.939 [0.891-0.986] at cutoff 0.33 ng/mL) measurement, whereas the corrected total leukocyte count assay (0.906 [0.850-0.962] at cutoff 350 cells/mm3) had diagnostic properties moderately superior to uncorrected total leukocyte count measurement (0.870 [0.798-0.943] at cutoff 430 cells/mm3). Conclusion: Cerebrospinal fluid levels of procalcitonin, lactate, and lactate-ratio are reliable markers to diagnose bacterial meningitis in blood-contaminated cerebrospinal fluid. |
| Databáze: | OpenAIRE |
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