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Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis

  • Sérgio Monteiro de Almeida EMAIL logo , Juliane Rosa Castoldi and Salomão Cury Riechi
Published/Copyright: April 6, 2023
Diagnosis
From the journal Diagnosis Volume 10 Issue 3

Abstract

Objectives

Given the difficulty in the differential diagnosis of acute bacterial meningitis (BM) and viral meningitis (VM), we aimed to compare the ability of cerebrospinal fluid (CSF) biomarkers, such as lactate, glucose, lactate dehydrogenase (LDH), C-reactive protein (CRP), total white blood cell count, and predominance of neutrophils, as single tests to differentiate microbiologically defined acute BM and VM.

Methods

CSF samples were divided into three groups: BM (n=17), VM (n=14) (both with the etiological agent identified), and normal control groups (n=26).

Results

All the biomarkers studied were significantly higher in the BM group than in the VM or control groups (p>0.05). CSF lactate showed the best diagnostic clinical performance characteristics: sensitivity (94.12%), specificity (100%), positive and negative predictive value (100 and 97.56%, respectively), positive and negative likelihood ratio (38.59 and 0.06, respectively), accuracy (98.25%), and AUC (0.97). CSF CRP is excellent for screening BM and VM, as its best feature is its specificity (100%). CSF LDH is not recommended for screening or case-finding. LDH levels were higher in Gram-negative diplococcus than in Gram-positive diplococcus. Other biomarkers were not different between Gram-positive and negative bacteria. The highest level of agreement between the CSF biomarkers was between CSF lactate and CRP [kappa coefficient, 0.91 (0.79; 1.00)].

Conclusions

All markers showed significant differences between the studied groups and were increased in acute BM. CSF lactate is better than the other biomarkers studied for screening acute BM due to its high specificity.

Keywords: biomarkers; C-reactive protein; cerebrospinal fluid; lactate; LDH; meningitis
Corresponding author: Sérgio Monteiro de Almeida, MD, PhD, Clinical Laboratory, Hospital de Clínicas–UFPR, Seção de Virologia, Setor Análises Clínicas, Rua Padre Camargo, 280 Curitiba, PR, Brazil, PR, 80060 240, Brazil; and Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal do Parana, Curitiba, PR, Brazil, Phone: +55 (41) 3360-7974, E-mail:

Funding source: no funding

  1. Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  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. Juliane Rosa Castoldi and Salomão Cury Riechi: data collection and article revision.

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

  4. Informed consent: Not applicable.

  5. Ethical approval: This study was approved by the Institutional Research Review Board of the Hospital de Clínicas, Universidade Federal do Paraná (HC-UFPR), Brazil (CAAE n 40364714.7.0000.0096).

  6. Data availability: Prof. Sergio Monteiro de Almeida declares that he has full access to all of the data, which is available after Institutional Review Board approval.

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Received: 2023-01-31
Accepted: 2023-03-23
Published Online: 2023-04-06

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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  3. Cognitive biases in internal medicine: a scoping review
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  19. Development of a student-created internal medicine frameworks website for healthcare trainees
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https://doi.org/10.1515/dx-2023-0013
Keywords for this article
biomarkers; C-reactive protein; cerebrospinal fluid; lactate; LDH; meningitis

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Cognitive biases in internal medicine: a scoping review
  4. Opinion Papers
  5. “Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template
  6. Developing a European longitudinal and interprofessional curriculum for clinical reasoning
  7. Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity
  8. Reframing context specificity in team diagnosis using the theory of distributed cognition
  9. Original Articles
  10. Promoting clinical reasoning with meta-memory techniques to teach broad differential diagnosis generation in a pediatric core clerkship
  11. Semantic competence and prototypical verbalizations are associated with higher OSCE and global medical degree scores: a multi-theory pilot study on year 6 medical student verbalizations
  12. Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment
  13. Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care
  14. Quantitation of neurofilament light chain protein in serum and cerebrospinal fluid from patients with multiple sclerosis using the MSD R-PLEX NfL assay
  15. Analysis of common biomarkers in capillary blood in routine clinical laboratory. Preanalytical and analytical comparison with venous blood
  16. Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis
  17. Short Communications
  18. Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes
  19. Development of a student-created internal medicine frameworks website for healthcare trainees
  20. Case Report - Lessons in Clinical Reasoning
  21. Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of crushing, substernal chest pain
  22. Letters to the Editor
  23. Ample room for cognitive bias in diagnosing accidental hypothermia
  24. Auscultation order of lung and heart sounds and autonomous noise cancellation
  25. Reliability of a single-nostril nasopharyngeal swab for diagnosing SARS-CoV-2 infection
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