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Cerebrospinal fluid lactate and pyruvate concentrations and their ratio in children: age-related reference intervals
Jean-François Benoist1, Corinne Alberti, Sandrine Leclercq
1Service de Biochimie-Hormonologie, Hôpital Robert Debré, Paris, France.
Insights
Cerebrospinal fluid lactate and pyruvate levels in children vary slightly with age. Establishing age-adjusted reference intervals is crucial for diagnosing central nervous system disorders in pediatric patients.
Area of Science:
- Biochemistry
- Pediatric Neurology
- Clinical Chemistry
Background:
- Cerebrospinal fluid (CSF) lactate and pyruvate concentrations, and their ratio, are vital biomarkers for diagnosing central nervous system disorders.
- Current diagnostic reference values lack age-specific data for pediatric populations.
Purpose of the Study:
- To establish age-related reference intervals for CSF lactate and pyruvate concentrations and the lactate/pyruvate ratio in children.
- To provide age-adjusted reference data for improved diagnosis of pediatric neurological conditions.
Main Methods:
- Retrospective analysis of 197 hospitalized children's CSF and blood lactate/pyruvate data.
- Application of regression modeling to normalize and smooth age-dependent values.
- Determination of 10th-90th percentiles to establish reference intervals.
Main Results:
- CSF lactate, pyruvate, and lactate/pyruvate ratio showed slight age-related variations.
- The 90th percentile upper limits varied from 1.78-1.88 mmol/L (lactate), 148-139 µmol/L (pyruvate), and 16.9-19.2 (L/P ratio) from birth to 186 months.
- Sensitivity for detecting inborn errors of metabolism (respiratory chain disorders) was highest for lactate (73%).
Conclusions:
- CSF lactate and pyruvate concentrations and their ratio exhibit minor age-related changes in children.
- Recommended average 90th percentile values for infants up to 24 months are 1.8 mmol/L (lactate), 147 µmol/L (pyruvate), and 17 (L/P ratio).
- Age-adjusted reference intervals are recommended for older children, particularly for values near the 90th percentile.
Background:
Lactate (L) and pyruvate (P) concentrations in cerebrospinal fluid (CSF) and the L/P ratio have diagnostic value in numerous primary and acquired disorders affecting the central nervous system, but age-related reference values are not available for children.
Methods:
We analyzed CSF and blood lactate and pyruvate concentrations and their ratio in a 4-year retrospective survey of a children's hospital laboratory database. Reference intervals (10th-90th percentiles) were established from data on 197 hospitalized children. A recent regression modeling method was used to normalize and smooth values against age. The model equation of best fit was calculated for each variable.
Results:
Slight age-related variations were shown by the model, with an increase in lactate, a decrease in pyruvate, and a resulting increase in the L/P ratio with increasing age. However, the SD did not vary with age. We defined the upper limit of the reference intervals as the 90th percentiles, which from birth to 186 months of age varied continuously from 1.78 to 1.88 mmol/L (6%), 148 to 139 micro mol/L (6%), and 16.9 to 19.2 (14%) for lactate, pyruvate, and the L/P ratio, respectively. At a threshold of 2 (in Z-score units), the sensitivity for a subgroup of inborn errors of metabolism (respiratory chain disorders) was 73%, 42%, and 31% for lactate, pyruvate, and the L/P ratio, respectively.
Conclusions:
In children, CSF lactate and pyruvate concentrations and their ratio appear to vary slightly with age. Average 90th percentile values of 1.8 mmol/L, 147 micro mol/L, and 17, respectively, could be used in infants up to 24 months of age. In older children, age-adjusted reference intervals should be used, especially when values are close to the 90th percentile.