Tema
Avaliação do lactato nas meningites
Introduction
The early diagnosis of infectious meningitis is difficullt. Indirect CSF findings often contribute to guide therapeutic approach, for instance, in deciding the use of antibiotics.
The aim of this study was to compare the diagnostic sensitivity of several CSF parameters for bacterial meningitis etiological definition.
Methods
CSF samples from community meningitis cases analyzed in “Senne Liquor Diagnostico” were included. We considered bacterial meningitis all the cases in which S. pneumoniae, N. meningitides, or H. influenzae were identified by bacterioscopy, culture, and or latex agglutination. We considered viral meningitis all the cases in which a virus was identified by polymerase chain reaction (PCR). Sensitivity analysis and ROC curve of leukocyte count, glucose, protein, and lactate were carried out for bacterial meningitis diagnosis.
Results
We included 634 cases of bacterial meningitis and 525 casos of viral meningitis. The greater area under the curve was of CSF lactate (AUC=0.995). The others AUCs were: glucose (AUC=0.091), protein (AUC=0,983), and leukocyte count (AUC=0,428). With CSF lactate cut-off of 30 mg/dl the sensitivity was 88.8% and the specificity was 93.3%. With CSF lactate cut-off of 30 mg/dl the sensitivity was 84.1% and the specificity was 99%.
Conclusion
CSF lactate was the parameter with better association with the diagnosis of bacterial meningitis.
The CSF lactate with cut-off of 30 mg/dl had high sensitivity and specificity for the diagnosis of bacterial meningitis diagnosis.