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Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis

Objectives: To identify and compare the cerebrospinal fluid (CSF) parameters that predict the presence of neonatal bacterial meningitis using optimal cutoff values, and to derive and compare predictive profiles based on a combination of individual parameters for the same purpose. Study Design: The r...

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Autores principales: Huang, Heyu, Tan, Jintong, Gong, Xiaohui, Li, Jing, Wang, Liping, Xu, Min, Zhang, Xi, Zhang, Yongjun, Huang, Lisu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351467/
https://www.ncbi.nlm.nih.gov/pubmed/30728800
http://dx.doi.org/10.3389/fneur.2019.00012
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author Huang, Heyu
Tan, Jintong
Gong, Xiaohui
Li, Jing
Wang, Liping
Xu, Min
Zhang, Xi
Zhang, Yongjun
Huang, Lisu
author_facet Huang, Heyu
Tan, Jintong
Gong, Xiaohui
Li, Jing
Wang, Liping
Xu, Min
Zhang, Xi
Zhang, Yongjun
Huang, Lisu
author_sort Huang, Heyu
collection PubMed
description Objectives: To identify and compare the cerebrospinal fluid (CSF) parameters that predict the presence of neonatal bacterial meningitis using optimal cutoff values, and to derive and compare predictive profiles based on a combination of individual parameters for the same purpose. Study Design: The retrospective component of the Shanghai Neonate Meningitis Cohort included all term neonates who underwent lumbar puncture between 2000 and 2017. Those with severe neurological diseases, histories of ventricular drainage, or traumatic lumbar punctures were excluded. Reference ranges were determined for non-bacterial meningitis neonates based on the 5th, 25th, 50th, 75th, and 95th CSF parameter quantiles, and their relationships with age were calculated using generalized additive models that tested for linear relationships. The optimal cutoff value for each measured CSF parameter was calculated using receiver operating characteristic analysis and by deriving the Youden's index. Parameters with good diagnostic efficacies were combined to produce predictive profiles using logistic regression. The diagnostic efficacies of the single parameters and profiles were compared in neonates with confirmed bacterial meningitis. Results: White blood cells (WBCs) in CSF showed a higher diagnostic ability for neonatal bacterial meningitis than CSF protein, glucose, lactate dehydrogenase, or chloride. The sensitivity and specificity of the diagnostic cutoff value for WBCs (20 × 10(6)/L) were 95.1 and 98.7%, respectively. Profiles based on CSF parameter combinations improved the specificities slightly to 99.0–99.7%. However, employing predictive profiles did not improve sensitivities, which remained at 95.1–96.0%. Conclusions: Profiles for predicting neonatal bacterial meningitis improve the sensitivity and specificity of diagnosis slightly, although not appreciably, compared to the single parameter of CSF WBC alone.
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spelling pubmed-63514672019-02-06 Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis Huang, Heyu Tan, Jintong Gong, Xiaohui Li, Jing Wang, Liping Xu, Min Zhang, Xi Zhang, Yongjun Huang, Lisu Front Neurol Neurology Objectives: To identify and compare the cerebrospinal fluid (CSF) parameters that predict the presence of neonatal bacterial meningitis using optimal cutoff values, and to derive and compare predictive profiles based on a combination of individual parameters for the same purpose. Study Design: The retrospective component of the Shanghai Neonate Meningitis Cohort included all term neonates who underwent lumbar puncture between 2000 and 2017. Those with severe neurological diseases, histories of ventricular drainage, or traumatic lumbar punctures were excluded. Reference ranges were determined for non-bacterial meningitis neonates based on the 5th, 25th, 50th, 75th, and 95th CSF parameter quantiles, and their relationships with age were calculated using generalized additive models that tested for linear relationships. The optimal cutoff value for each measured CSF parameter was calculated using receiver operating characteristic analysis and by deriving the Youden's index. Parameters with good diagnostic efficacies were combined to produce predictive profiles using logistic regression. The diagnostic efficacies of the single parameters and profiles were compared in neonates with confirmed bacterial meningitis. Results: White blood cells (WBCs) in CSF showed a higher diagnostic ability for neonatal bacterial meningitis than CSF protein, glucose, lactate dehydrogenase, or chloride. The sensitivity and specificity of the diagnostic cutoff value for WBCs (20 × 10(6)/L) were 95.1 and 98.7%, respectively. Profiles based on CSF parameter combinations improved the specificities slightly to 99.0–99.7%. However, employing predictive profiles did not improve sensitivities, which remained at 95.1–96.0%. Conclusions: Profiles for predicting neonatal bacterial meningitis improve the sensitivity and specificity of diagnosis slightly, although not appreciably, compared to the single parameter of CSF WBC alone. Frontiers Media S.A. 2019-01-23 /pmc/articles/PMC6351467/ /pubmed/30728800 http://dx.doi.org/10.3389/fneur.2019.00012 Text en Copyright © 2019 Huang, Tan, Gong, Li, Wang, Xu, Zhang, Zhang and Huang. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Huang, Heyu
Tan, Jintong
Gong, Xiaohui
Li, Jing
Wang, Liping
Xu, Min
Zhang, Xi
Zhang, Yongjun
Huang, Lisu
Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis
title Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis
title_full Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis
title_fullStr Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis
title_full_unstemmed Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis
title_short Comparing Single vs. Combined Cerebrospinal Fluid Parameters for Diagnosing Full-Term Neonatal Bacterial Meningitis
title_sort comparing single vs. combined cerebrospinal fluid parameters for diagnosing full-term neonatal bacterial meningitis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351467/
https://www.ncbi.nlm.nih.gov/pubmed/30728800
http://dx.doi.org/10.3389/fneur.2019.00012
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