Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis
Author:
de Almeida Sérgio Monteiro12, Kussen Gislene B.3, Cogo Laura L.3, Nogueira Keite3
Affiliation:
1. Virology Section Clinical Pathology Laboratory Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil 2. CSF Section Clinical Pathology Laboratory Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil 3. Bacteriology Section, Clinical Pathology Laboratory, Hospital De Clínicas , Federal University of Paraná , Curitiba , Brazil
Abstract
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.
Publisher
Walter de Gruyter GmbH
Subject
Biochemistry (medical),Clinical Biochemistry,Public Health, Environmental and Occupational Health,Health Policy,Medicine (miscellaneous)
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