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Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children
Mudasir Nazir1, Wasim Ahmad Wani1, Muzaffar Ahmad Malik1
1Sher-I-Kashmir Institute of Medical Sciences Hospital, Department of Pediatrics and Neonatology, Srinagar, India.
Objective:
To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation.
Methods:
Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded.
Results:
At a cut-off value of 3mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979.
Conclusions:
The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2mmol/L.
