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- Title
The Diagnostic Dilemma of Traumatic Lumbar Puncture: Current Standing of Cerebrospinal Fluid Leukocyte Corrections and Our Experience With Cerebrospinal Fluid Biomarkers.
- Authors
Nazir, Mudasir; Wani, Wasim Ahmad; Kawoosa, Khalid; Dar, Sheeraz Ahmad; Malik, Muzaffar; Mir, Naseer Yousuf; Ahmad, Ikhlas; Bhat, Rais Ahmad; Bhat, Javeed Iqbal; Ahmad, Qazi Iqbal; Charoo, Bashir Ahmad; Ali, Syed Wajid
- Abstract
Objective: To assess the diagnostic efficiency of cerebrospinal fluid markers of procalcitonin, lactate, and cerebrospinal fluid/serum lactate ratio for detecting bacterial meningitis during traumatic lumbar puncture, and to compare these markers with routinely used uncorrected and corrected leukocyte measurements. Methods: Infants aged ≤90 days with traumatic lumbar puncture were prospectively studied. The diagnostic characteristics of cerebrospinal fluid assays of uncorrected and corrected leukocyte count, procalcitonin, lactate, and lactate ratio were described and compared. Results: Considering the area under the curve (95% CI) analysis and standard cutoff values, the lactate-ratio (0.985 [0.964-0.989] at cutoff 1.2) had the best test indexes for identifying meningitis, followed by lactate (0.964 [0.945-0.984] at cutoff 2.2 mmol/L) and procalcitonin (0.939 [0.891-0.986] at cutoff 0.33 ng/mL) measurement, whereas the corrected total leukocyte count assay (0.906 [0.850-0.962] at cutoff 350 cells/mm3) had diagnostic properties moderately superior to uncorrected total leukocyte count measurement (0.870 [0.798-0.943] at cutoff 430 cells/mm3). Conclusion: Cerebrospinal fluid levels of procalcitonin, lactate, and lactate-ratio are reliable markers to diagnose bacterial meningitis in blood-contaminated cerebrospinal fluid.
- Subjects
LUMBAR puncture; CEREBROSPINAL fluid; BIOLOGICAL tags; INFANT health; INFANT diseases
- Publication
Journal of Child Neurology, 2018, Vol 33, Issue 7, p441
- ISSN
0883-0738
- Publication type
Article
- DOI
10.1177/0883073818761719