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Hematologic parameters to predict negative cerebrospinal fluid examination results among neurologically intact patients who underwent lumbar puncture on suspicion of central nervous system infection

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Cerebrospinal fluid (CSF) examination is mandatory whenever central nervous system (CNS) infection is suspected. However, pleocytosis is not detected in a substantial number of suspected patients who undergo CSF examination. This study aimed to identify parameters that can aid in predicting negative CSF examination results (defined as a white blood cell count of <5 cells/high-power field).

Methods: The study included 101 neurologically intact patients who underwent lumbar puncture because of suspicion of CNS infection. Patients were divided into negative and positive CSF examination groups, and their initial blood tests were comparatively analyzed.

Results: The negative group had a significantly higher proportion of neutrophils in white blood cells (81.5% vs. 75.8%, P=0.012), lower proportion of lymphocytes in white blood cells (9.3% vs. 16.7%, P=0.001), a higher neutrophil-to-lymphocyte ratio (9.1 vs. 4.4, P=0.001), a lower lymphocyte-to-monocyte ratio (1.6 vs. 2.4, P=0.008), and a higher C-reactive protein level (21.0 vs. 5.0 mg/L, P<0.001) than the positive group. In the receiver-operating characteristic analysis, neutrophil-to-lymphocyte ratio and C-reactive protein had an area under the curve of >0.7, and the best cutoff values were 6.0 (accuracy 70.3%) and 12.7 mg/L (accuracy 76.2%), respectively.

Conclusion: The neutrophil-to-lymphocyte ratio ≥6 and C-reactive protein level ≥12.7 mg/L was significantly associated with negative CSF examination result.

No MeSH data available.


Schematic diagram of the flow of the investigation and analysis. ED, emergency depertment; ROC, receiver operating characteristic.
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f1-ceem-16-152: Schematic diagram of the flow of the investigation and analysis. ED, emergency depertment; ROC, receiver operating characteristic.

Mentions: A lumbar puncture was performed in 212 patients from October 2014 to September 2015 in our ED. Of these patients, 111 were excluded. Among the excluded patients, 16 had no evidence of fever, 44 had decreased or altered mental status (seizure 3, sedative drug overdose 3, metabolic encephalopathy 10, encephalitis 15, cerebral infarction 8, brain abscess 2, and unknown cause 3), 37 underwent CSF examination for purposes other than diagnosis of an acute CNS infection (demyelinating disease 17, myelitis 7, neuritis 4, hydrocephalus 3, brain syphilis 1, and metastatic malignant tumor 5), 5 had a hematologic disease, 1 had acquired immunodeficiency syndrome, and 8 had been transferred from another hospital to our hospital. Finally, 101 alert and oriented patients with fever and acute headache were included in this study. All the subjects underwent a lumbar puncture in the ED, of whom 45 had positive CSF test results (CSF pleocytosis) and 56 had negative results (no CSF pleocytosis) (Fig. 1).


Hematologic parameters to predict negative cerebrospinal fluid examination results among neurologically intact patients who underwent lumbar puncture on suspicion of central nervous system infection
Schematic diagram of the flow of the investigation and analysis. ED, emergency depertment; ROC, receiver operating characteristic.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5385510&req=5

f1-ceem-16-152: Schematic diagram of the flow of the investigation and analysis. ED, emergency depertment; ROC, receiver operating characteristic.
Mentions: A lumbar puncture was performed in 212 patients from October 2014 to September 2015 in our ED. Of these patients, 111 were excluded. Among the excluded patients, 16 had no evidence of fever, 44 had decreased or altered mental status (seizure 3, sedative drug overdose 3, metabolic encephalopathy 10, encephalitis 15, cerebral infarction 8, brain abscess 2, and unknown cause 3), 37 underwent CSF examination for purposes other than diagnosis of an acute CNS infection (demyelinating disease 17, myelitis 7, neuritis 4, hydrocephalus 3, brain syphilis 1, and metastatic malignant tumor 5), 5 had a hematologic disease, 1 had acquired immunodeficiency syndrome, and 8 had been transferred from another hospital to our hospital. Finally, 101 alert and oriented patients with fever and acute headache were included in this study. All the subjects underwent a lumbar puncture in the ED, of whom 45 had positive CSF test results (CSF pleocytosis) and 56 had negative results (no CSF pleocytosis) (Fig. 1).

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Cerebrospinal fluid (CSF) examination is mandatory whenever central nervous system (CNS) infection is suspected. However, pleocytosis is not detected in a substantial number of suspected patients who undergo CSF examination. This study aimed to identify parameters that can aid in predicting negative CSF examination results (defined as a white blood cell count of <5 cells/high-power field).

Methods: The study included 101 neurologically intact patients who underwent lumbar puncture because of suspicion of CNS infection. Patients were divided into negative and positive CSF examination groups, and their initial blood tests were comparatively analyzed.

Results: The negative group had a significantly higher proportion of neutrophils in white blood cells (81.5% vs. 75.8%, P=0.012), lower proportion of lymphocytes in white blood cells (9.3% vs. 16.7%, P=0.001), a higher neutrophil-to-lymphocyte ratio (9.1 vs. 4.4, P=0.001), a lower lymphocyte-to-monocyte ratio (1.6 vs. 2.4, P=0.008), and a higher C-reactive protein level (21.0 vs. 5.0 mg/L, P<0.001) than the positive group. In the receiver-operating characteristic analysis, neutrophil-to-lymphocyte ratio and C-reactive protein had an area under the curve of >0.7, and the best cutoff values were 6.0 (accuracy 70.3%) and 12.7 mg/L (accuracy 76.2%), respectively.

Conclusion: The neutrophil-to-lymphocyte ratio ≥6 and C-reactive protein level ≥12.7 mg/L was significantly associated with negative CSF examination result.

No MeSH data available.