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Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis

  • Sérgio Monteiro de Almeida EMAIL logo , Gislene B. Kussen , Laura L. Cogo and Keite Nogueira
Published/Copyright: December 8, 2022
Diagnosis
From the journal Diagnosis Volume 10 Issue 2

Abstract

Objectives

The definitive diagnosis of tuberculous meningitis (TBM) is achieved by identifying Mycobacterium tuberculosis (MTb) in cerebrospinal fluid (CSF); however, diagnostic confirmation is difficult due to the inability of current tests for an effective diagnosis. Our objective was to retrospectively assess the characteristics of CSF lactate (CSF-LA) as an adjunct biomarker in the diagnosis of TBM.

Methods

608 CSF laboratory reports were assessed. Of these, 560 had clinically suspected TBM. These were classified as definite (n=36), probable (23), possible (278), or non-TBM (223) according to the international consensus TBM case definitions. An additional 48 CSF samples were negative controls with normal CSF.

Results

Against a reference standard of definite TBM, the cut-off value for CSF-LA was 4.0 mmol/L, the area under the ROC curve was 0.88 (95% CI, 0.82–0.94; p=0.0001), sensitivity was 69%, specificity 90%, negative predictive value 98%. These diagnostic parameters decreased when calculated against those of the other categories of TBM. CSF-LA exhibited high specificity, efficiency, negative predictive value, and clinical utility index in all the groups studied.

Conclusions

CSF-LA is a useful diagnostic marker to rule out TBM when associated with conventional microbiology tests, nucleic acid amplification assays, and clinical algorithms, particularly in endemic areas.

Keywords: cerebrospinal fluid; lactate; diagnosis; meningeal tuberculosis; tuberculosis
Corresponding author: Sérgio Monteiro de Almeida, MD, PhD, Virology Section, Clinical Pathology Laboratory, Hospital De Clínicas, Federal University of Paraná, Rua Padre Camargo, 280, Curitiba, PR, 80060-240, Brasil; and CSF Section, Clinical Pathology Laboratory, Hospital De Clínicas, Federal University of Paraná, Curitiba, Brazil, Phone/Fax: 55 (41) 3360-7974, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Sérgio Monteiro de Almeida: data collection and analysis, article preparation, writing, and revision. Gislene B. Kussen: data collection, article revision. Laura L. Cogo: data collection, article revision. Keite Nogueira: data collection and analysis, article revision. This study was approved by the Institutional Research Review Board of the Hospital de Clínicas, Universidade Federal do Paraná (HC-UFPR), Brazil (CAAE 40364714.7.0000.0096).

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2022-0102).

Received: 2022-09-22
Accepted: 2022-11-22
Published Online: 2022-12-08

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2022-0102
Keywords for this article
cerebrospinal fluid; lactate; diagnosis; meningeal tuberculosis; tuberculosis

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. An equation for excellence in clinical reasoning
  4. Quantifying diagnostic excellence
  5. Review
  6. A scoping review of distributed cognition in acute care clinical decision-making
  7. Opinion Papers
  8. Context matters: toward a multilevel perspective on context in clinical reasoning and error
  9. Occam’s razor and Hickam’s dictum: a dermatologic perspective
  10. Original Articles
  11. Differences in clinical reasoning between female and male medical students
  12. Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum
  13. Bad things can happen: are medical students aware of patient centered care and safety?
  14. Impact of diagnostic checklists on the interpretation of normal and abnormal electrocardiograms
  15. Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis
  16. Empowering quality data – the Gordian knot of bringing real innovation into healthcare system
  17. Collective intelligence improves probabilistic diagnostic assessments
  18. Why people fail to participate in annual skin cancer screening: creation of the perceptions of annual skin cancer screening scale (PASCSS)
  19. Instructions on appropriate fasting prior to phlebotomy; effects on patient awareness, preparation, and biochemical parameters
  20. Clinician factors associated with delayed diagnosis of appendicitis
  21. Real-world assessment of the clinical performance of COVID-VIRO ALL IN rapid SARS-CoV-2 antigen test
  22. Lack of a prompt normalization of immunological parameters is associated with long-term care and poor prognosis in COVID-19 affected patients receiving convalescent plasma: a single center experience
  23. Letters to the Editor
  24. Uncontrolled confounding in COVID-19 epidemiology
  25. VAPES: a new mnemonic for considering paroxysmal disorders
  26. Congress Abstracts
  27. SIDM2022 15th Annual International Conference
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