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Critical Care
Published in: Critical Care 6/2010

Open Access 01-12-2010 | Research

Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis

Authors: Nguyen T Huy, Nguyen TH Thao, Doan TN Diep, Mihoko Kikuchi, Javier Zamora, Kenji Hirayama

Published in: Critical Care | Issue 6/2010

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Abstract

Introduction

Making a differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical problem. The utility of a cerebrospinal fluid (CSF) lactate assay for this purpose has been debated and is not yet routinely clinically performed. To adequately evaluate this assay, a systematic review and meta-analysis of studies of the CSF lactate concentration as a marker for both bacterial meningitis and aseptic meningitis was performed.

Methods

Electronic searches in PubMed, Scopus, the MEDION database and the Cochrane Library were conducted to identify relevant articles published before March 2009. A manual search of reference lists from selected articles was also conducted. Two reviewers independently selected relevant articles and extracted data on study characteristics, quality and accuracy.

Results

Twenty-five articles were identified that met the eligibility criteria. Diagnostic odds ratios were considerably homogenous (Chi-square P = 0.1009, I 2 = 27.6%), and the homogeneity was further confirmed by a Galbraith plot and meta-regression analysis using several covariates. The symmetrical summary receiver-operator characteristic curve (SROC), fitted using the Moses-Shapiro-Littenberg method, was positioned near the upper left corner of the SROC curve. The Q value and area under the curve were 0.9451 and 0.9840, respectively, indicating excellent accuracy. The diagnostic accuracy of the CSF lactate concentration was higher than those of other four conventional markers (CSF glucose, CSF/plasma glucose quotient, CSF protein, and CSF total number of leukocytes) using a head to head meta-analysis of the 25 included studies.

Conclusions

To distinguish bacterial meningitis from aseptic meningitis, CSF lactate is a good single indicator and a better marker compared to other conventional markers.
Appendix
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Metadata
Title
Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis
Authors
Nguyen T Huy
Nguyen TH Thao
Doan TN Diep
Mihoko Kikuchi
Javier Zamora
Kenji Hirayama
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9395

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