Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children

Abstract

Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis (BM) from viral meningitis (VM) in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut‐off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between BM and VM, the area under the curve (AUC) for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut‐off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for BM, mean levels in VM remain essentially below 2 mmol/L.

Keywords

• CSF culture
• Pneumococcal meningitis
• CSF markers