Role of Cerebrospinal Fluid Lactate in Diagnosing Meningitis in Critically Ill Patients

Overview

Journal World J Crit Care Med

Publisher Baishideng Publishing Group

Specialty Critical Care

Date 2023 Jan 23

PMID 36683964

Authors

Devraj Yadav

Omender Singh

Deven Juneja

Amit Goel

Sahil Kataria

Anisha Beniwal

Affiliations

Soon will be listed here.

Abstract

Background: Meningitis is a life-threatening clinical condition associated with high mortality and morbidity. Early diagnosis and specific treatment may improve outcomes. Lack of specific clinical signs or tests make the diagnosis challenging.

Aim: To assess the efficacy of cerebrospinal fluid (CSF) lactate in diagnosing meningitis in critically ill patients.

Methods: A prospective, observational cohort study was carried out in a neuro-medical intensive care unit (ICU) over a 22 mo period. Adult patients, with suspected meningitis admitted in ICU, were serially recruited. Patients who refused consent, those with peripheral sensorineural deficit, or with any contraindication to lumber puncture were excluded. CSF cytology, bio-chemistry, lactates, culture and polymerase chain reaction based meningo-encephalitis panel were evaluated. Patients were divided in two groups based on clinical diagnosis of meningitis. The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.

Results: Seventy-one patients were included and 23 were diagnosed with meningitis. The mean values of CSF total leucocyte count (TLC), proteins and lactates were significantly higher in meningitis group. There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel. CSF lactate (> 2.72 mmol/L) showed good accuracy in diagnosing meningitis with an area under the curve of 0.81 (95% confidence interval: 0.69-0.93), sensitivity of 82.6%, and specificity 72.9%. These values were comparable to those of CSF TLC and protein. Twelve patients with bacterial meningitis had significantly higher CSF lactate (8.9 ± 4.7 mmol/L) than those with non-bacterial meningitis (4.2 ± 3.8 mmol/L), = 0.006.

Conclusion: CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients. CSF lactate (> 2.72 mmol/L) showed good accuracy, sensitivity, and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.

Citing Articles

Diagnostic Utility of Procalcitonin and Lactate Determination in Cerebrospinal Fluid for the Diagnosis of Neonatal Meningitis.

Borowiak A, Safranow K, Sarna A, Loniewska B J Clin Med. 2025; 14(2).

PMID: 39860420 PMC: 11765884. DOI: 10.3390/jcm14020414.

The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis.

Nitsch L, Ehrentraut S, Grobe-Einsler M, Bode F, Banat M, Schneider M Diagnostics (Basel). 2023; 13(7).

PMID: 37046531 PMC: 10093535. DOI: 10.3390/diagnostics13071313.

References

Leib S, Kim Y, Black S, Tureen J, Tauber M . Inducible nitric oxide synthase and the effect of aminoguanidine in experimental neonatal meningitis. J Infect Dis. 1998; 177(3):692-700. DOI: 10.1086/514226. View

Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila R, Kotilainen P . Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006; 66(1):75-80. DOI: 10.1212/01.wnl.0000191407.81333.00. View

ROOS . Bacterial Meningitis. Curr Treat Options Neurol. 2000; 1(2):147-156. DOI: 10.1007/s11940-999-0014-8. View

Nazir M, Wani W, Malik M, Mir M, Ashraf Y, Kawoosa K . Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children. J Pediatr (Rio J). 2017; 94(1):88-92. DOI: 10.1016/j.jped.2017.03.007. View

Vincent J, Rello J, Marshall J, Silva E, Anzueto A, Martin C . International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009; 302(21):2323-9. DOI: 10.1001/jama.2009.1754. View

Holbrook I, Beetham R, Cruickshank A, Egner W, Fahie-Wilson M, Keir G . National audit of cerebrospinal fluid testing. Ann Clin Biochem. 2007; 44(Pt 5):443-8. DOI: 10.1258/000456307781646085. View

Tavares W, Machado A, Matushita H, Plese J . CSF markers for diagnosis of bacterial meningitis in neurosurgical postoperative patients. Arq Neuropsiquiatr. 2006; 64(3A):592-5. DOI: 10.1590/s0004-282x2006000400012. View

Baheerathan A, Pitceathly R, Curtis C, Davies N . CSF lactate. Pract Neurol. 2020; 20(4):320-323. DOI: 10.1136/practneurol-2019-002191. View

Sacchi C, Fukasawa L, Goncalves M, Salgado M, Shutt K, Carvalhanas T . Incorporation of real-time PCR into routine public health surveillance of culture negative bacterial meningitis in São Paulo, Brazil. PLoS One. 2011; 6(6):e20675. PMC: 3120771. DOI: 10.1371/journal.pone.0020675. View

10.

Bryan J, de Silva H, Tavares A, Rocha H, Scheld W . Etiology and mortality of bacterial meningitis in northeastern Brazil. Rev Infect Dis. 1990; 12(1):128-35. DOI: 10.1093/clinids/12.1.128. View

11.

Wu H, Cordeiro S, Harcourt B, Carvalho M, Azevedo J, Oliveira T . Accuracy of real-time PCR, Gram stain and culture for Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae meningitis diagnosis. BMC Infect Dis. 2013; 13:26. PMC: 3558362. DOI: 10.1186/1471-2334-13-26. View

12.

McGill F, Heyderman R, Michael B, Defres S, Beeching N, Borrow R . The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016; 72(4):405-38. DOI: 10.1016/j.jinf.2016.01.007. View

13.

Mount H, Boyle S . Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention. Am Fam Physician. 2017; 96(5):314-322. View

14.

Singh L, Javali M, Mehta A, Pradeep R, Srinivasa R, Acharya P . Study of cerebrospinal fluid levels of lactate, lactate dehydrogenase and adenosine deaminase in the diagnosis and outcome of acute meningitis. Neurol Res. 2021; 44(5):463-467. DOI: 10.1080/01616412.2021.2004366. View

15.

Carbonnelle E . [Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. Med Mal Infect. 2009; 39(7-8):581-605. DOI: 10.1016/j.medmal.2009.02.017. View

16.

Schwarz S, Bertram M, Schwab S, Andrassy K, Hacke W . Serum procalcitonin levels in bacterial and abacterial meningitis. Crit Care Med. 2000; 28(6):1828-32. DOI: 10.1097/00003246-200006000-00024. View

17.

Tarai B, Das P . FilmArray® meningitis/encephalitis (ME) panel, a rapid molecular platform for diagnosis of CNS infections in a tertiary care hospital in North India: one-and-half-year review. Neurol Sci. 2018; 40(1):81-88. DOI: 10.1007/s10072-018-3584-y. View

18.

. Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018; 17(12):1061-1082. PMC: 6234314. DOI: 10.1016/S1474-4422(18)30387-9. View

19.

Huy N, Thao N, Diep D, Kikuchi M, Zamora J, Hirayama K . Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. Crit Care. 2011; 14(6):R240. PMC: 3220013. DOI: 10.1186/cc9395. View

20.

Lee B, Davies H . Aseptic meningitis. Curr Opin Infect Dis. 2007; 20(3):272-7. DOI: 10.1097/QCO.0b013e3280ad4672. View