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Published on: November 29, 2019
Validated age-specific reference values for CSF total protein levels in children
V Kahlmann1, J Roodbol1, N van Leeuwen2
1Department of Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands; Department of Paediatric Neurology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands.
Insights
New age-specific reference values for cerebrospinal fluid (CSF) total protein in children improve diagnosis of Guillain-Barré syndrome (GBS) and acute disseminated encephalomyelitis (ADEM). These findings offer more sensitive diagnostic tools for pediatric neurological conditions.
Area of Science:
- Pediatric Neurology
- Clinical Biochemistry
Background:
- Cerebrospinal fluid (CSF) total protein levels are crucial biomarkers in pediatric neurological disorders.
- Existing reference values for CSF total protein in children lack age specificity, potentially impacting diagnostic accuracy.
Purpose of the Study:
- To establish age-specific reference values for CSF total protein in pediatric populations.
- To validate these new reference values in children diagnosed with Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM), and multiple sclerosis (MS).
Main Methods:
- Analysis of 6145 diagnostic CSF samples from 3623 children (<18 years) to define reference ranges.
- Confirmation of reference values using a subgroup of 378 children with conditions unrelated to elevated CSF protein.
- Validation of reference values in pediatric cohorts diagnosed with GBS, ADEM, and MS.
Main Results:
- Established age-specific upper limits of normal for CSF total protein: 0.25 g/L (6 months-6 years), 0.28 g/L (6-12 years), and 0.34 g/L (12-18 years).
- CSF protein levels in infants (<6 months) were highly variable (median 0.47 g/L).
- The new values identified elevated CSF protein in 85% of GBS, 66% of ADEM, and 23% of MS cases, showing higher sensitivity.
Conclusions:
- Accurate, age-specific reference values for pediatric CSF total protein have been determined.
- The newly defined reference values demonstrate increased sensitivity for diagnosing GBS and ADEM in children compared to existing standards.
Objective:
To define age-specific reference values for cerebrospinal fluid (CSF) total protein levels for children and validate these values in children with Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS).
Methods:
Reference values for CSF total protein levels were determined in an extensive cohort of diagnostic samples from children (<18 year) evaluated at Erasmus Medical Center/Sophia Children's Hospital. These reference values were confirmed in children diagnosed with disorders unrelated to raised CSF total protein level and validated in children with GBS, ADEM and MS.
Results:
The test results of 6145 diagnostic CSF samples from 3623 children were used to define reference values. The reference values based on the upper limit of the 95% CI (i.e. upper limit of normal) were for 6 months-2 years 0.25 g/L, 2-6 years 0.25 g/L, 6-12 years 0.28 g/L, 12-18 years 0.34 g/L. These reference values were confirmed in a subgroup of 378 children diagnosed with disorders that are not typically associated with increased CSF total protein. In addition, the CSF total protein levels in these children in the first 6 months after birth were highly variable (median 0.47 g/L, IQR 0.26-0.65). According to these new reference values, CSF total protein level was elevated in 85% of children with GBS, 66% with ADEM and 23% with MS.
Conclusion:
More accurate age-specific reference values for CSF total protein levels in children were determined. These new reference values are more sensitive than currently used values for diagnosing GBS and ADEM in children.
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