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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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Age-specific CSF glucose, CSF/plasma glucose ratio and CSF lactate values.(A) CSF glucose concentration in 8,871 samples. CSF samples with CSF glucose >10.0 mmol/L (n = 4) are not shown; (B) CSF/plasma glucose in 4,516 samples. CSF samples with CSF/plasma glucose >1.5 (n = 5) are not shown; (C) CSF lactate concentration in 7,614 samples. CSF samples with CSF lactate >5000 µmol/L (n = 22) are not shown. Lines indicate 5th and 95th percentile values.
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pone-0042745-g002: Age-specific CSF glucose, CSF/plasma glucose ratio and CSF lactate values.(A) CSF glucose concentration in 8,871 samples. CSF samples with CSF glucose >10.0 mmol/L (n = 4) are not shown; (B) CSF/plasma glucose in 4,516 samples. CSF samples with CSF/plasma glucose >1.5 (n = 5) are not shown; (C) CSF lactate concentration in 7,614 samples. CSF samples with CSF lactate >5000 µmol/L (n = 22) are not shown. Lines indicate 5th and 95th percentile values.

Mentions: CSF glucose concentrations were measured in 8,871 out of 9,036 (98%) CSF samples. CSF glucose ranged from 1.0 to 11.9 mmol/L (mean 3.42 mmol/L; SD 0.769). CSF glucose concentrations were age-dependent with remarkably low 5th percentile values until the age of 6 months (1.7–2.0 mmol/L) (Fig. 2A and Table S1). After the age of 6 months the CSF glucose 5th percentile values gradually increased over the entire age range studied (from 2.4 to 2.9 mmol/L). CSF glucose 95th percentile values were highest in neonates (5.6 mmol/L) and lowest in patients aged 3–6 months (3.9 mmol/L) and 3–4 years (3.8 mmol/l). Above the age of 4 years a gradual increase in the CSF glucose 95th percentile was seen (from 4.0 to 6.1 mmol/L). After exclusion of CSF samples from patients with an abnormal or unknown plasma glucose level at the moment of lumbar puncture, the CSF glucose 5th percentile value did not show a change of >10% of the original value. CSF glucose 95th percentile values, however, did change more than 10% in patients aged 4–8 weeks, 3–12 months and ≥60 years after the application of these exclusion criteria. Numbers were unaffected in the other age groups.


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)

Age-specific CSF glucose, CSF/plasma glucose ratio and CSF lactate values.(A) CSF glucose concentration in 8,871 samples. CSF samples with CSF glucose >10.0 mmol/L (n = 4) are not shown; (B) CSF/plasma glucose in 4,516 samples. CSF samples with CSF/plasma glucose >1.5 (n = 5) are not shown; (C) CSF lactate concentration in 7,614 samples. CSF samples with CSF lactate >5000 µmol/L (n = 22) are not shown. Lines indicate 5th and 95th percentile values.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0042745-g002: Age-specific CSF glucose, CSF/plasma glucose ratio and CSF lactate values.(A) CSF glucose concentration in 8,871 samples. CSF samples with CSF glucose >10.0 mmol/L (n = 4) are not shown; (B) CSF/plasma glucose in 4,516 samples. CSF samples with CSF/plasma glucose >1.5 (n = 5) are not shown; (C) CSF lactate concentration in 7,614 samples. CSF samples with CSF lactate >5000 µmol/L (n = 22) are not shown. Lines indicate 5th and 95th percentile values.
Mentions: CSF glucose concentrations were measured in 8,871 out of 9,036 (98%) CSF samples. CSF glucose ranged from 1.0 to 11.9 mmol/L (mean 3.42 mmol/L; SD 0.769). CSF glucose concentrations were age-dependent with remarkably low 5th percentile values until the age of 6 months (1.7–2.0 mmol/L) (Fig. 2A and Table S1). After the age of 6 months the CSF glucose 5th percentile values gradually increased over the entire age range studied (from 2.4 to 2.9 mmol/L). CSF glucose 95th percentile values were highest in neonates (5.6 mmol/L) and lowest in patients aged 3–6 months (3.9 mmol/L) and 3–4 years (3.8 mmol/l). Above the age of 4 years a gradual increase in the CSF glucose 95th percentile was seen (from 4.0 to 6.1 mmol/L). After exclusion of CSF samples from patients with an abnormal or unknown plasma glucose level at the moment of lumbar puncture, the CSF glucose 5th percentile value did not show a change of >10% of the original value. CSF glucose 95th percentile values, however, did change more than 10% in patients aged 4–8 weeks, 3–12 months and ≥60 years after the application of these exclusion criteria. Numbers were unaffected in the other age groups.

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