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Cerebrospinal fluid protein concentration in pediatric patients: defining clinically relevant reference values
M Wong1, B L Schlaggar, R S Buller
1Department of Neurology, Washington University School of Medicine, St Louis, MO, USA. wong_m@kids.wustl.edu
Archives of Pediatrics & Adolescent Medicine
|August 2, 2000
Summary
Pediatric cerebrospinal fluid (CSF) protein reference values vary significantly by age, with adult norms being inappropriate. Age-specific CSF protein levels are crucial for accurate diagnosis in children, especially when considering enterovirus-polymerase chain reaction (EV-PCR) results.
Area of Science:
- Pediatric Neurology
- Clinical Chemistry
- Infectious Disease Diagnostics
Background:
- Establishing accurate reference ranges for cerebrospinal fluid (CSF) protein is essential for diagnosing pediatric meningitis.
- Traditional diagnostic criteria may not always align with molecular findings like enterovirus-polymerase chain reaction (EV-PCR).
Purpose of the Study:
- To define age-specific, clinically relevant reference values for CSF protein concentrations in pediatric patients.
- To evaluate the impact of enterovirus-polymerase chain reaction (EV-PCR) positivity on CSF protein levels in children.
Main Methods:
- Analysis of CSF protein concentrations in 906 pediatric patients.
- Derivation of age-dependent reference values from a control group of 225 patients without meningitis or neurologic disease.
- Testing of CSF samples for EV-PCR in a subset of the reference group.
Main Results:
- CSF protein concentration is highest and most variable in neonates (approx. 1.0 g/L), decreasing by 6 months and remaining low until adolescence.
- EV-PCR was positive in 11% of the reference group.
- EV-PCR-positive patients aged 4 months to 14 years showed significantly higher CSF protein levels than EV-PCR-negative patients.
Conclusions:
- CSF protein reference values demonstrate significant age-dependent variations in pediatric populations.
- Adult reference values for CSF protein are not appropriate for children.
- The presence of EV-PCR in some patients without meningitis highlights the need for age-and variable-specific reference groups for laboratory values.