Infectious Disease · Neurology · 2 h ago
CSF lactate shows high sensitivity for bacterial meningitis in meta-analysis
A systematic review and meta-analysis of 27 studies involving 5,673 patients assessed the diagnostic accuracy of commonly used cerebrospinal fluid tests in suspected acute meningitis. CSF lactate had the highest pooled sensitivity among the reported measures, while Gram stain was highly specific but had pathogen-dependent sensitivity.
- Meta-analysis included 27 studies and 5,673 patients.
- CSF lactate sensitivity was 94% and specificity 86%.
- Gram stain specificity was 99%, with pathogen-dependent sensitivity.
- Authors call for research on test combinations and biomarkers.
Researchers conducted a systematic review and meta-analysis to assess the diagnostic accuracy of cerebrospinal fluid (CSF) Gram stain, cell counts and differential, glucose, total protein, and lactate for bacterial meningitis. The analysis included 27 studies with 5,673 patients and evaluated sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve. The work was undertaken in preparation for World Health Organization guidance on meningitis diagnosis, treatment, and care.
CSF lactate had a pooled sensitivity of 94% (95% CI 91–98%) and specificity of 86% (95% CI 74–98%). Gram stain had 85% sensitivity (95% CI 55–96%) and 99% specificity; sensitivity varied by pathogen, from 93% for *Streptococcus pneumoniae* to 10–25% for *Listeria monocytogenes*. CSF leukocyte count had 77% sensitivity and 83% specificity, while total protein had 86% sensitivity and 79% specificity. The CSF-to-blood glucose ratio showed 88% sensitivity and 78% specificity.
The findings support interpreting CSF measures together with the clinical picture rather than relying on a single result. Accuracy estimates varied, particularly for Gram stain by pathogen, and the authors called for further study of test combinations and novel biomarkers. The study was supported by WHO, with no external funding reported; the authors declared no competing interests.
In practice
For patients evaluated for suspected acute meningitis, these pooled estimates show that CSF measures have differing diagnostic strengths: Gram stain was highly specific, whereas CSF lactate had the highest reported pooled sensitivity. No single measure was shown to be definitive, and Gram-stain sensitivity differed substantially by pathogen. The review supports considering CSF findings in combination with the clinical assessment, but it does not establish a new diagnostic pathway; test combinations and novel biomarkers require further study.
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BMC Medicine: Diagnostic performance of cerebrospinal fluid examination in cases with suspected acute meningitis: a systematic review and meta-analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.