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

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Title: Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: A meta-analysis
Authors: Sakushima, Ken Browse this author
Hayashino, Yasuaki Browse this author
Kawaguchi, Takehiko Browse this author
Jackson, Jeffrey L. Browse this author
Fukuhara, Shunichi Browse this author
Keywords: Meningitis
Cerebrospinal fluid
Lactate
Meta-analysis
Issue Date: Apr-2011
Publisher: Elsevier
Journal Title: Journal of Infection
Volume: 62
Issue: 4
Start Page: 255
End Page: 262
Publisher DOI: 10.1016/j.jinf.2011.02.010
PMID: 21382412
Abstract: 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.
Type: article (author version)
URI: http://hdl.handle.net/2115/48503
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 佐久嶋 研

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