Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults: a Danish prospective observational cohort study

Kristian Buch; Jacob Bodilsen; Andreas Knudsen; Lykke Larsen; Jannik Helweg-Larsen; Merete Storgaard; Christian Brandt; Lothar Wiese; Christian Østergaard; Henrik Nielsen; Anne Mette Lebech; for the Danish Study Group for Infections in the Brain

doi:10.1080/23744235.2018.1441539

Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults: a Danish prospective observational cohort study

Kristian Buch^*, Jacob Bodilsen, Andreas Knudsen, Lykke Larsen, Jannik Helweg-Larsen, Merete Storgaard, Christian Brandt, Lothar Wiese, Christian Østergaard, Henrik Nielsen, Anne Mette Lebech, for the Danish Study Group for Infections in the Brain

^*Corresponding author for this work

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

Background: The ability of cerebrospinal fluid (CSF) lactate to distinguish between acute bacterial meningitis (ABM) and aseptic meningitis/encephalitis (AME) is debated. We assessed the diagnostic value of CSF lactate to discriminate between ABM and AME. Methods: We included 176 patients from a prospective adult cohort with neuroinfections. In total, 51 ABM and 125 AME patients with clinically and/or microbiologically diagnosed acute meningitis were examined with CSF-lactate and traditional markers for infection. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results: In CSF, lactate, leukocytes, fraction of neutrophils, protein and glucose ratio, were significantly different between the ABM and AME groups. CSF lactate had the best diagnostic value, with an area under the curve (AUC) of 0.976 (95%CI 0.966–0.997) and using a cut-off of 3.5 mmol/L a sensitivity of 96% and specificity of 85%. Antibiotic treatment before lumbar puncture had no significant effect on the AUC of CSF lactate. Conclusions: Compared to traditional CSF-markers, CSF lactate is more accurate to distinguish between ABM and AME.

Original language	English
Journal	Infectious Diseases
Volume	50
Issue number	7
Pages (from-to)	514-521
Number of pages	8
ISSN	2374-4235
DOIs	https://doi.org/10.1080/23744235.2018.1441539
Publication status	Published - 2018

Keywords

Acute bacterial meningitis
Aseptic meningitis
CSF lactate
Encephalitis

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Buch, K., Bodilsen, J., Knudsen, A., Larsen, L., Helweg-Larsen, J., Storgaard, M., Brandt, C., Wiese, L., Østergaard, C., Nielsen, H., Lebech, A. M., & for the Danish Study Group for Infections in the Brain (2018). Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults: a Danish prospective observational cohort study. Infectious Diseases, 50(7), 514-521. https://doi.org/10.1080/23744235.2018.1441539

Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults : a Danish prospective observational cohort study. / Buch, Kristian; Bodilsen, Jacob; Knudsen, Andreas et al.

In: Infectious Diseases, Vol. 50, No. 7, 2018, p. 514-521.

Research output: Contribution to journal › Journal article › Research › peer-review

Buch, K, Bodilsen, J, Knudsen, A, Larsen, L, Helweg-Larsen, J, Storgaard, M, Brandt, C, Wiese, L, Østergaard, C, Nielsen, H, Lebech, AM & for the Danish Study Group for Infections in the Brain 2018, 'Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults: a Danish prospective observational cohort study', Infectious Diseases, vol. 50, no. 7, pp. 514-521. https://doi.org/10.1080/23744235.2018.1441539

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title = "Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults: a Danish prospective observational cohort study",

abstract = "Background: The ability of cerebrospinal fluid (CSF) lactate to distinguish between acute bacterial meningitis (ABM) and aseptic meningitis/encephalitis (AME) is debated. We assessed the diagnostic value of CSF lactate to discriminate between ABM and AME. Methods: We included 176 patients from a prospective adult cohort with neuroinfections. In total, 51 ABM and 125 AME patients with clinically and/or microbiologically diagnosed acute meningitis were examined with CSF-lactate and traditional markers for infection. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results: In CSF, lactate, leukocytes, fraction of neutrophils, protein and glucose ratio, were significantly different between the ABM and AME groups. CSF lactate had the best diagnostic value, with an area under the curve (AUC) of 0.976 (95%CI 0.966–0.997) and using a cut-off of 3.5 mmol/L a sensitivity of 96% and specificity of 85%. Antibiotic treatment before lumbar puncture had no significant effect on the AUC of CSF lactate. Conclusions: Compared to traditional CSF-markers, CSF lactate is more accurate to distinguish between ABM and AME.",

keywords = "Acute bacterial meningitis, Aseptic meningitis, CSF lactate, Encephalitis",

author = "Kristian Buch and Jacob Bodilsen and Andreas Knudsen and Lykke Larsen and Jannik Helweg-Larsen and Merete Storgaard and Christian Brandt and Lothar Wiese and Christian {\O}stergaard and Henrik Nielsen and Lebech, {Anne Mette} and {for the Danish Study Group for Infections in the Brain}",

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T1 - Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults

T2 - a Danish prospective observational cohort study

AU - Buch, Kristian

AU - Bodilsen, Jacob

AU - Knudsen, Andreas

AU - Larsen, Lykke

AU - Helweg-Larsen, Jannik

AU - Storgaard, Merete

AU - Brandt, Christian

AU - Wiese, Lothar

AU - Østergaard, Christian

AU - Nielsen, Henrik

AU - Lebech, Anne Mette

AU - for the Danish Study Group for Infections in the Brain

PY - 2018

Y1 - 2018

N2 - Background: The ability of cerebrospinal fluid (CSF) lactate to distinguish between acute bacterial meningitis (ABM) and aseptic meningitis/encephalitis (AME) is debated. We assessed the diagnostic value of CSF lactate to discriminate between ABM and AME. Methods: We included 176 patients from a prospective adult cohort with neuroinfections. In total, 51 ABM and 125 AME patients with clinically and/or microbiologically diagnosed acute meningitis were examined with CSF-lactate and traditional markers for infection. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results: In CSF, lactate, leukocytes, fraction of neutrophils, protein and glucose ratio, were significantly different between the ABM and AME groups. CSF lactate had the best diagnostic value, with an area under the curve (AUC) of 0.976 (95%CI 0.966–0.997) and using a cut-off of 3.5 mmol/L a sensitivity of 96% and specificity of 85%. Antibiotic treatment before lumbar puncture had no significant effect on the AUC of CSF lactate. Conclusions: Compared to traditional CSF-markers, CSF lactate is more accurate to distinguish between ABM and AME.

AB - Background: The ability of cerebrospinal fluid (CSF) lactate to distinguish between acute bacterial meningitis (ABM) and aseptic meningitis/encephalitis (AME) is debated. We assessed the diagnostic value of CSF lactate to discriminate between ABM and AME. Methods: We included 176 patients from a prospective adult cohort with neuroinfections. In total, 51 ABM and 125 AME patients with clinically and/or microbiologically diagnosed acute meningitis were examined with CSF-lactate and traditional markers for infection. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results: In CSF, lactate, leukocytes, fraction of neutrophils, protein and glucose ratio, were significantly different between the ABM and AME groups. CSF lactate had the best diagnostic value, with an area under the curve (AUC) of 0.976 (95%CI 0.966–0.997) and using a cut-off of 3.5 mmol/L a sensitivity of 96% and specificity of 85%. Antibiotic treatment before lumbar puncture had no significant effect on the AUC of CSF lactate. Conclusions: Compared to traditional CSF-markers, CSF lactate is more accurate to distinguish between ABM and AME.

KW - Acute bacterial meningitis

KW - Aseptic meningitis

KW - CSF lactate

KW - Encephalitis

U2 - 10.1080/23744235.2018.1441539

DO - 10.1080/23744235.2018.1441539

M3 - Journal article

C2 - 29490540

AN - SCOPUS:85042939270

SN - 2374-4235

VL - 50

SP - 514

EP - 521

JO - Infectious Diseases

JF - Infectious Diseases

IS - 7

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