Molecular Biomarkers & Diagnosis

CSF Lactate an Independent and Reliable Biomarker among the CSF Parameters to Differntiate Bacterial Meningitis from Aseptic Meningitis

Abstract

Karthika Remash, Ravi Raj, Gopala Krishna M. Pillai, Gireesh Kumar K.P., Lakshmi A, Atthulya Mangal

Objective: To compare the mean values of CSF parameters (lactate, protein, sugar, ADA) and thereby distinguish between cases of bacterial and non-bacterial meningitis. Materials and methods: A cross sectional study was conducted in which 60 adult patients were included and CSF parameters (differential counts, protein, sugar, ADA, lactate) were in analyzed in 22 patients of bacterial meningitis and 38 patients of aseptic meningitis. Data were analyzed using SPSS version 21.0. Descriptive statistics are represented using frequencies and percentages. Analytical statistics were represented using Chi-square test for the comparison of categorical variables. The mean values were compared using independent t- test. Results: Among the other CSF parameters, the mean value of CSF lactate and CSF sugars were found to have significant difference (p-value 0.01) in bacterial and non-bacterial meningitis. With a cut off value of 3 mmol/l, CSF lactate was useful in differentiating bacterial meningitis from aseptic meningitis. However other parameters including CSF protein and CSF ADA did not show significant difference between bacterial meningitis including TBM and non-bacterial meningitis, whereas CSF lactate also showed significant difference in TBM and viral meningitis. It was also found out that mortality is proportionately increased with the increasing lactate levels. Conclusion: This study concludes that CSF lactate is an important, independent and reliable biomarker with a cut off value of 3mmol/L, to differentiate bacterial meningitis including TBM from nonbacterial meningitis. TBM and viral meningitis are difficult to differentiate due to their similar clinical features and lab parameters. In such cases, CSF lactate can be taken as a reliable differentiating marker. CSF lactate can be used when CSF gram stain and cultures are inconclusive and time consuming. Thus, helps in initiating early treatment and achieving better outcomes.