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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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Relation between plasma glucose and CSF glucose.(A) Relation between plasma glucose and CSF/plasma glucose ratio in 4,508 CSF samples. CSF samples with CSF/plasma glucose ratio >1.5 (n = 5) are not shown. (B) Relation between plasma glucose and CSF glucose in 4,513 CSF samples. The grey areas indicates normoglycemia (plasma glucose >3.0 and <7.8 mmol/L).
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pone-0042745-g003: Relation between plasma glucose and CSF glucose.(A) Relation between plasma glucose and CSF/plasma glucose ratio in 4,508 CSF samples. CSF samples with CSF/plasma glucose ratio >1.5 (n = 5) are not shown. (B) Relation between plasma glucose and CSF glucose in 4,513 CSF samples. The grey areas indicates normoglycemia (plasma glucose >3.0 and <7.8 mmol/L).

Mentions: A linear relation between plasma glucose and CSF glucose was found (Figure 3A). Hypoglycemia was associated with an increased CSF/plasma glucose ratio in most patients, whereas hyperglycemia was associated with only a minimal decrease of the CSF/plasma glucose ratio in the majority of the samples (Figure 3B).


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)

Relation between plasma glucose and CSF glucose.(A) Relation between plasma glucose and CSF/plasma glucose ratio in 4,508 CSF samples. CSF samples with CSF/plasma glucose ratio >1.5 (n = 5) are not shown. (B) Relation between plasma glucose and CSF glucose in 4,513 CSF samples. The grey areas indicates normoglycemia (plasma glucose >3.0 and <7.8 mmol/L).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0042745-g003: Relation between plasma glucose and CSF glucose.(A) Relation between plasma glucose and CSF/plasma glucose ratio in 4,508 CSF samples. CSF samples with CSF/plasma glucose ratio >1.5 (n = 5) are not shown. (B) Relation between plasma glucose and CSF glucose in 4,513 CSF samples. The grey areas indicates normoglycemia (plasma glucose >3.0 and <7.8 mmol/L).
Mentions: A linear relation between plasma glucose and CSF glucose was found (Figure 3A). Hypoglycemia was associated with an increased CSF/plasma glucose ratio in most patients, whereas hyperglycemia was associated with only a minimal decrease of the CSF/plasma glucose ratio in the majority of the samples (Figure 3B).

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