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Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice.

Leen WG, Willemsen MA, Wevers RA, Verbeek MM - PLoS ONE (2012)

Bottom Line: In 1993 The Nijmegen Observational CSF Study was started.Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age.These reference values allow a reliable interpretation of CSF results in everyday clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands. w.leen@neuro.umcn.nl

ABSTRACT
Cerebrospinal fluid (CSF) analysis is an important tool in the diagnostic work-up of many neurological disorders, but reference ranges for CSF glucose, CSF/plasma glucose ratio and CSF lactate based on studies with large numbers of CSF samples are not available. Our aim was to define age-specific reference values. In 1993 The Nijmegen Observational CSF Study was started. Results of all CSF samples that were analyzed between 1993 and 2008 at our laboratory were systematically collected and stored in our computerized database. After exclusion of CSF samples with an unknown or elevated erythrocyte count, an elevated leucocyte count, elevated concentrations of bilirubin, free hemoglobin, or total protein 9,036 CSF samples were further studied for CSF glucose (n = 8,871), CSF/plasma glucose ratio (n = 4,516) and CSF lactate values (n = 7,614). CSF glucose, CSF/plasma glucose ratio and CSF lactate were age-, but not sex dependent. Age-specific reference ranges were defined as 5-95(th) percentile ranges. CSF glucose 5(th) percentile values ranged from 1.8 to 2.9 mmol/L and 95(th) percentile values from 3.8 to 5.6 mmol/L. CSF/plasma glucose ratio 5(th) percentile values ranged from 0.41 to 0.53 and 95(th) percentile values from 0.82 to 1.19. CSF lactate 5(th) percentile values ranged from 0.88 to 1.41 mmol/L and 95(th) percentile values from 2.00 to 2.71 mmol/L. Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age. These reference values allow a reliable interpretation of CSF results in everyday clinical practice. Furthermore, hypoglycemia was associated with an increased CSF/plasma glucose ratio, whereas hyperglycemia did not affect the CSF/plasma glucose ratio.

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Flow chart of inclusion of CSF samples.N – number of CSF samples.
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pone-0042745-g001: Flow chart of inclusion of CSF samples.N – number of CSF samples.

Mentions: In September 1993 The Nijmegen Observational CSF was started. Results of all CSF samples that were analyzed at the laboratory of our tertiary referral hospital, the Radboud University Nijmegen Medical Centre in Nijmegen, The Netherlands (www.neurochemistry.nl) were systematically collected and stored in our computerized database. This study was approved by the local Medical Ethical Committee, METC Arnhem – Nijmegen. Since laboratory data had routinely been stored in the hospital database and were anonymously processed for the purpose of this study, the METC waived the need for patient informed consent. CSF samples that were analyzed between September 1993 and December 2008 (n = 23,618) were included. To define reference values for glucose and lactate in CSF obtained by lumbar puncture we have excluded (1) all CSF samples from patients from the neurosurgical ward or intensive care units (where CSF is often obtained from ventricular shunts); and CSF samples with (2) an erythrocyte count ≥200/µL or unknown erythrocyte count; (3) a bilirubin concentration ≥0.5 µmol/L and/or a free hemoglobin concentration ≥0.25 µmol/L; (4) an elevated leucocyte count; or (5) an elevated total protein concentration (Fig. 1). We have used strict exclusion criteria for leucocyte count and total protein concentration based on age-specific reference values as given in figure 1[9]–[12]. In a previous study we identified all patients with GLUT1DS in our CSF database (n = 3) [13]. These patients were excluded from the present study. We finally included 9,036 CSF samples for further analyses. Patient population consisted of 49.7% males and 50.3% females. The population was predominantly Caucasian.


Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice.

Leen WG, Willemsen MA, Wevers RA, Verbeek MM - PLoS ONE (2012)

Flow chart of inclusion of CSF samples.N – number of CSF samples.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3412827&req=5

pone-0042745-g001: Flow chart of inclusion of CSF samples.N – number of CSF samples.
Mentions: In September 1993 The Nijmegen Observational CSF was started. Results of all CSF samples that were analyzed at the laboratory of our tertiary referral hospital, the Radboud University Nijmegen Medical Centre in Nijmegen, The Netherlands (www.neurochemistry.nl) were systematically collected and stored in our computerized database. This study was approved by the local Medical Ethical Committee, METC Arnhem – Nijmegen. Since laboratory data had routinely been stored in the hospital database and were anonymously processed for the purpose of this study, the METC waived the need for patient informed consent. CSF samples that were analyzed between September 1993 and December 2008 (n = 23,618) were included. To define reference values for glucose and lactate in CSF obtained by lumbar puncture we have excluded (1) all CSF samples from patients from the neurosurgical ward or intensive care units (where CSF is often obtained from ventricular shunts); and CSF samples with (2) an erythrocyte count ≥200/µL or unknown erythrocyte count; (3) a bilirubin concentration ≥0.5 µmol/L and/or a free hemoglobin concentration ≥0.25 µmol/L; (4) an elevated leucocyte count; or (5) an elevated total protein concentration (Fig. 1). We have used strict exclusion criteria for leucocyte count and total protein concentration based on age-specific reference values as given in figure 1[9]–[12]. In a previous study we identified all patients with GLUT1DS in our CSF database (n = 3) [13]. These patients were excluded from the present study. We finally included 9,036 CSF samples for further analyses. Patient population consisted of 49.7% males and 50.3% females. The population was predominantly Caucasian.

Bottom Line: In 1993 The Nijmegen Observational CSF Study was started.Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age.These reference values allow a reliable interpretation of CSF results in everyday clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands. w.leen@neuro.umcn.nl

ABSTRACT
Cerebrospinal fluid (CSF) analysis is an important tool in the diagnostic work-up of many neurological disorders, but reference ranges for CSF glucose, CSF/plasma glucose ratio and CSF lactate based on studies with large numbers of CSF samples are not available. Our aim was to define age-specific reference values. In 1993 The Nijmegen Observational CSF Study was started. Results of all CSF samples that were analyzed between 1993 and 2008 at our laboratory were systematically collected and stored in our computerized database. After exclusion of CSF samples with an unknown or elevated erythrocyte count, an elevated leucocyte count, elevated concentrations of bilirubin, free hemoglobin, or total protein 9,036 CSF samples were further studied for CSF glucose (n = 8,871), CSF/plasma glucose ratio (n = 4,516) and CSF lactate values (n = 7,614). CSF glucose, CSF/plasma glucose ratio and CSF lactate were age-, but not sex dependent. Age-specific reference ranges were defined as 5-95(th) percentile ranges. CSF glucose 5(th) percentile values ranged from 1.8 to 2.9 mmol/L and 95(th) percentile values from 3.8 to 5.6 mmol/L. CSF/plasma glucose ratio 5(th) percentile values ranged from 0.41 to 0.53 and 95(th) percentile values from 0.82 to 1.19. CSF lactate 5(th) percentile values ranged from 0.88 to 1.41 mmol/L and 95(th) percentile values from 2.00 to 2.71 mmol/L. Reference ranges for all three parameters were widest in neonates and narrowest in toddlers, with lower and upper limits increasing with age. These reference values allow a reliable interpretation of CSF results in everyday clinical practice. Furthermore, hypoglycemia was associated with an increased CSF/plasma glucose ratio, whereas hyperglycemia did not affect the CSF/plasma glucose ratio.

Show MeSH
Related in: MedlinePlus