Published online Jan 9, 2023. doi: 10.5492/wjccm.v12.i1.1
Peer-review started: November 7, 2022
First decision: November 25, 2022
Revised: November 30, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 9, 2023
Processing time: 56 Days and 18.5 Hours
Meningitis is a life-threatening clinical condition associated with high mortality and morbidity. Early diagnosis and specific treatment may improve outcomes. Lack of specific clinical signs or tests make the diagnosis challenging, especially in critically ill patients.
Cerebrospinal fluid (CSF) lactate has been used to diagnose meningitis in post-operative neurosurgical patients. However, there is a dearth of data from neuro-medical patients regarding its role in diagnosing meningitis.
To assess the efficacy of CSF lactate in diagnosing meningitis in critically ill patients.
A prospective, observational cohort study was carried out in a neuro-medical intensive care unit (ICU). CSF cytology, bio-chemistry, lactates, culture and polymerase chain reaction based meningo-encephalitis panel were evaluated. Patients were divided in two groups based on clinical diagnosis of meningitis. The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.
Seventy-one patients were included and 23 were diagnosed with meningitis. The mean values of CSF total leucocyte count, proteins and lactates were significantly higher in meningitis group. There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel. CSF lactate (> 2.72 mmol/L) showed good accuracy in diagnosing meningitis with an area under the curve of 0.81 (95% confidence interval: 0.69-0.93), sensitivity 82.6%, and specificity 72.9%. Patients with bacterial meningitis had significantly higher CSF lactate (8.9 ± 4.7 mmol/L) than those with non-bacterial meningitis (4.2 ± 3.8 mmol/L), P = 0.006.
CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients. CSF lactate (> 2.72 mmol/L) showed good accuracy, sensitivity, and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.
Larger trials may assess the utility of CSF lactate in differentiating various infective meningitis like those secondary to bacterial, fungal, viral and tubercular bacilli.