open access

https://hdl.handle.net/2115/48503

Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: A meta-analysis

英語

Meta-analysis

2011-04

Elsevier

Journal of Infection

62(4)

255-262

Objectives: Cerebrospinal fluid (CSF) lactate is produced by bacterial anaerobic metabolism and is not affected by blood lactate concentration, an advantage over CSF glucose in differentiating bacterial meningitis from aseptic meningitis. However, the previous investi- gations have shown mixed results of the sensitivity and specificity. Our study’s purpose was to assess the utility of CSF lactate in differentiating bacterial meningitis from aseptic meningitis. Methods: We searched MEDLINE and EMBASE for clinical studies that included CSF lactate mea- surement in bacterial meningitis and aseptic meningitis. Test characteristics were pooled using hierarchical summary ROC curve and random effects model. Results: Thirty three studies were included. The pooled test characteristics of CSF lactate were sensitivity 0.93 (95% CI: 0.89 e 0.96), specificity 0.96 (95% CI: 0.93 e 0.98), likelihood ratio positive 22.9 (95% CI: 12.6 e 41.9), likelihood ratio negative 0.07 (95% CI: 0.05 e 0.12), and diag- nostic odds ratio 313 (95% CI: 141 e 698). Pretreatment with antibiotics lowered the sensitivity 0.49 (95% CI: 0.23 e 0.75). CSF lactate of around 35 mg/dl (34 e 36 mg/dl) had higher sensitivity and specificity than those of around 27 mg/dl (26 e 28 mg/dl). Conclusions: CSFlactate’s highnegative likelihoodratio may make it useful for rulingoutbacterial meningitis though pretreatment with antibiotics reduces clinical accuracy. CSF lactate of 35 mg/dl could be optimal cut-off value for distinguishing bacterial meningitis from aseptic meningitis.

学術雑誌論文

Accepted Manuscript

0163-4453

AA00258231