Clinical performance of amperometry compared with enzymatic ultra violet method for lactate quantification in cerebrospinal fluid
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Sérgio Monteiro de Almeida
,
Nagyla Barros
Abstract
Objectives
The differential diagnosis between acute bacterial meningitis (BM) and viral meningitis (VM) is crucial for treatment and prognosis. Cerebrospinal fluid (CSF) lactate (LA) is considered a good biomarker for differentiating BM from VM. The objective of this study was to compare the clinical performance of amperometry, which is not validated for measurement of LA in CSF samples, with a validated method (enzymatic ultra violet), for their ability to discriminate between acute BM and VM.
Methods
It was a retrospective, descriptive comparative study, 320 CSF reports were included; LA was quantified in CSF using either Dimension AR machine (Dade Behring) or amperometry (RAPID Point 500, Siemens). All samples with bacteria (n=54) or virus (n=139) identified, compared with a control with normal CSF (n=127).
Results
CSF LA levels were comparable for amperometry or enzymatic methods on each group studied, in a wide range of LA levels; it was capable to distinguish BM from VM independent of the method used to quantify.
Conclusions
The findings support the use of the amperometric method in measuring LA concentrations in CSF in a wide range of values. Amperometry is a less expensive method, validated for blood, easily available in small laboratories including in limited resources countries.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The study was approved by the Institutional Review Board of the Hospital de Clinicas, Universidade Federal do Paraná, Brazil, and was done in compliance with the World Medical Association Declaration of Helsinki.
References
1. McGill, F, Heyderman, RS, Panagiotou, S, Tunkel, AR, Solomon, T. Acute bacterial meningitis in adults. Lancet 2016;388:3036–47. https://doi.org/10.1016/s0140-6736(16)30654-7.Search in Google Scholar
2. Vidal, LR, Almeida, SM, Messias-Reason, IJ, Nogueira, MB, Debur Mdo, C, Pessa, LF, et al. Enterovirus and herpesviridae family as etiologic agents of lymphomonocytary meningitis, Southern Brazil. Arq Neuropsiquiatr 2011;69:475−81. https://doi.org/10.1590/s0004-282x2011000400013.Search in Google Scholar PubMed
3. Fishman, RA. Cerebrospinal fluid in diseases of the nervous system. Philadelphia: Saunders; 1992.Search in Google Scholar
4. de Almeida, SM, Furlan, SMP, Cretella, AMM, Lapinski, B, Nogueira, K, Cogo, LL, et al. Comparison of cerebrospinal fluid biomarkers for differential diagnosis of acute bacterial and viral meningitis with atypical cerebrospinal fluid characteristics. Med Princ Pract 2019;3:1–11.10.1159/000501925Search in Google Scholar PubMed PubMed Central
5. Galen, RS, Gambino, SR. Beyond normality, the predictive value and efficiency of medical diagnoses. New York: Wiley & Sons; 1975.Search in Google Scholar
6. Mitchell, AJ. The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis. Int J Geriatr Psychiatry 2008;23:1191–202. https://doi.org/10.1002/gps.2053.Search in Google Scholar PubMed
7. Mitchell, AJ. Sensitivity × PPV is a recognized test called the clinical utility index (CUI+). Eur J Epidemiol 2011;26:251–2. https://doi.org/10.1007/s10654-011-9561-x.Search in Google Scholar PubMed
8. McGee, S. Simplifying likelihood ratios. J Gen Intern Med 2002;17:647–50. https://doi.org/10.1046/j.1525-1497.2002.10750.x.Search in Google Scholar PubMed PubMed Central
9. Akobeng, AK. Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Paediatr 2007;96:487–91. https://doi.org/10.1111/j.1651-2227.2006.00179.x.Search in Google Scholar PubMed
10. Akobeng, AK. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Pædiatr 2007;96:644–7. https://doi.org/10.1111/j.1651-2227.2006.00178.x.Search in Google Scholar PubMed
11. de Almeida, SM, Faria, FL, de Goes, K, Buczenko, GM, Berto, DB, Raboni, SM, et al. Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases. Clin Chem Lab Med 2009;47:755–61. https://doi.org/10.1515/cclm.2009.160.Search in Google Scholar PubMed
12. de Almeida, SM, Boritza, K, Cogo, LL, Pessa, L, França, J, Rota, I, et al. Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis. Clin Chem Lab Med 2011;49:891–6. https://doi.org/10.1515/cclm.2011.131.Search in Google Scholar
13. Talukdar, B, Khalil, A, Sarkar, R, Saini, L. Meningococcal meningitis: clinical observations during an epidemic. Indian Pediatr 1988;25:329−34.Search in Google Scholar
14. Blazer, S, Berant, M, Alon, U. Bacterial meningitis: effect of antibiotic treatment on cerebrospinal fluid. Am Soc Clin Pathol 1983;80:376−7. https://doi.org/10.1093/ajcp/80.3.386.Search in Google Scholar PubMed
15. Kanegaye, JT, Soliemanzadeh, P, Bradley, JS. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Pediatrics 2001;108:1169–74.10.1542/peds.108.5.1169Search in Google Scholar
16. CLSI. A framework for using CLSI documents to evaluate clinical laboratory measurement procedures, 2nd ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2015, CLSI report EP19.Search in Google Scholar
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- Opinion Papers
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- (F)utility of urine Bence Jones proteins for “routine” screening for plasma cell dyscrasia
- COVID-19 and the Le Chatelier’s principle
- Original Articles
- Are sniffer dogs a reliable approach for diagnosing SARS-CoV-2 infection?
- Using body temperature and variables commonly available in the EHR to predict acute infection: a proof-of-concept study showing improved pretest probability estimates for acute COVID-19 infection among discharged emergency department patients
- Identifying children at high risk for infection-related decompensation using a predictive emergency department-based electronic assessment tool
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