ABSTRACT
BACKGROUND: Improved diagnostic tests would aid in diagnosing and treating community-acquired meningitis. OBJECTIVE: To analyze the diagnostic value of interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) of patients presenting with symptoms of acute meningitis. MATERIAL AND METHODS: In a 6-month prospective, observational, cross-sectional emergency department (ED) study, serum and CSF samples were obtained from all patients with a headache and fever in whom the physician suspected meningitis. Patients were excluded if computed tomography findings contraindicated a lumbar puncture, if they had bleeding disorders, or if their serum indicated bleeding. IL-6 levels were measured and compared in patients with (Group A) and without (Group B) bacterial meningitis. RESULTS: Samples were obtained from 53 patients, of whom 40 were ultimately found to have meningitis. These 40 patients averaged 49.6 ± 21.9 years, with number of men 18 (45%), hospitalizations 21 (52%), mortality 3 (.07%), and IL-6 average rating 491 (median: 14.5; range 0000-6000). Findings in the two groups were: Group A (with meningitis): n = 13, average IL-6 level: 1495 (median: 604; 25/75 percentiles: 232.5-2030; 95% confidence interval [CI] 371.7-2618.6; range 64-6000). Group B (with aseptic meningitis): n = 27, average IL-6 level: 7.34 (median: 5; 25/75 percentiles: 0.0/15.1; 95% CI 3.94-10.73; range 0-23.6). Mann-Whitney rank sum test: p < 0.0001. CONCLUSIONS: In patients with acute bacterial meningitis, CSF cytokine concentrations are elevated. Measuring CSF inflammatory cytokine levels in patients with acute meningitis could be a valuable ED diagnostic tool. Using this tool could improve the prognosis of patients with bacterial meningitis by allowing more rapid initiation of antibiotic treatment.
Subject(s)
Interleukin-6/cerebrospinal fluid , Meningitis, Aseptic/cerebrospinal fluid , Meningitis, Aseptic/diagnosis , Meningitis, Bacterial/cerebrospinal fluid , Meningitis, Bacterial/diagnosis , Acute Disease , Adolescent , Adult , Aged , Cross-Sectional Studies , Emergency Service, Hospital , Female , Fever/etiology , Headache/etiology , Hospitalization , Humans , Male , Meningitis, Haemophilus/cerebrospinal fluid , Meningitis, Haemophilus/diagnosis , Meningitis, Listeria/cerebrospinal fluid , Meningitis, Listeria/diagnosis , Meningitis, Meningococcal/cerebrospinal fluid , Meningitis, Meningococcal/diagnosis , Meningitis, Pneumococcal/cerebrospinal fluid , Meningitis, Pneumococcal/diagnosis , Middle Aged , Predictive Value of Tests , Prognosis , Prospective Studies , Statistics, Nonparametric , Young AdultABSTRACT
BACKGROUND: Impaired consciousness without a history of trauma is a common reason for emergency department (ED) visits. Among critically ill patients with a history and physical findings suggestive of a cerebrovascular accident (CVA), it may be difficult to differentiate between a structural and a non-structural cause for their condition. OBJECTIVES: This study was conducted to determine if lactic dehydrogenase (LDH) levels in the cerebrospinal fluid (CSF) of patients with acute non-traumatic neurological disorders could distinguish between structural and non-structural etiologies. MATERIAL AND METHODS: Over a 6-month period, CSF specimens were collected from 54 critically ill patients admitted to the ED with impaired consciousness and findings consistent with a CVA. The patients had moderate to severe impairment of consciousness, had a new motor or sensory deficit, or had meningeal signs of recent onset. CSF-LDH levels were analyzed because CSF levels of the enzyme are typically elevated in meningitis, metastatic cancer, and disorders resulting in ischemic necroses. Patients were excluded if a computed tomography scan showed contraindications to performing a lumbar puncture, if they had a coagulopathy, or if the CSF was xanthochromic or produced visible blood sediment after centrifuging. The data were analyzed according to the patients' admission diagnoses-structural vs. non-structural lesion. RESULTS: Of the samples collected from 54 patients, eight were excluded. Among the 46 patients included in the study, the mean age was 56.1 +/- 2.75 years, mean APACHE II score was 20.93 +/- 0.98, Glasgow Coma Scale (GCS) score was 7.15 +/- 0.49, and mortality was 55% (22 patients). The 30 patients with a structural abnormality had a mean age of 56.7 +/- 3.55 years, GCS score of 7.3 +/- 0.61, APACHE II score of 20.2 +/- 1.1, mortality of 43% (13 patients), and CSF-LDH level of 128.8 +/- 24.8 IU/L (95% confidence interval [CI] 78.1-179.6). The 16 patients with a non-structural (metabolic) disturbance had: a mean age of 55.0 +/- 4.42 years, GCS score of 6.87 +/- 0.86, APACHE II score of 22.2 +/- 1.94, mortality of 56% (9 patients), and CSF-LDH level of 29.8 +/- 2.9 IU/L (95% CI 23.6-36.1). Analysis by Student's t-test was p < 0.05. When the diagnostic value of CSF-LDH level was evaluated using a cutoff point of 40 IU/L, the following results were obtained: sensitivity: 86.7%, specificity: 81.3%, pretest likelihood: 65%, positive predictive value: 90%, negative predictive value: 76%, Likelihood Ratio (LR)+: 4.62, LR-: 0.16 (6.25-fold increase). CONCLUSIONS: In critically ill patients with acutely altered levels of consciousness but without a history of trauma, a CSF-LDH value < or = 40 IU/L is associated with non-structural pathology.
