High cerebrospinal fluid lactate concentration at 48 h of hospital admission predicts poor outcomes in patients with tuberculous meningitis: A multicenter retrospective cohort study

Chenchao Liu; Ruixue Huai; Yijia Xiang; Xu Han; Zixiang Chen; Yuhan Liu; Xingjun Liu; Huiquan Liu; Hong Zhang; Sihan Wang; Lingyu Hao; Yin Bo; Yuanbo Luo; Yiyi Wang; Yi Wang

doi:10.3389/fneur.2022.989832

High cerebrospinal fluid lactate concentration at 48 h of hospital admission predicts poor outcomes in patients with tuberculous meningitis: A multicenter retrospective cohort study

Front Neurol. 2022 Oct 6:13:989832. doi: 10.3389/fneur.2022.989832. eCollection 2022.

Authors

Chenchao Liu^{1

2

3

4}, Ruixue Huai⁵, Yijia Xiang^{3

4}, Xu Han^{3

4}, Zixiang Chen^{1

2}, Yuhan Liu⁶, Xingjun Liu^{1

2}, Huiquan Liu^{1

2}, Hong Zhang^{2

7}, Sihan Wang^{3

4}, Lingyu Hao^{3

4}, Yin Bo^{3

4}, Yuanbo Luo^{3

4}, Yiyi Wang^{1

2}, Yi Wang^{3

4}

Affiliations

¹ Department of Neurology, Haihe Clinical School, Tianjin Medical University, Tianjin, China.
² TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, Tianjin, China.
³ Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
⁴ Key Laboratory of Post-trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, Tianjin, China.
⁵ Department of Neurology, Tianjin Jinnan Hospital, Tianjin, China.
⁶ Department of Neurosurgery, People's Liberation Army Air Force Medical Center, Beijing, China.
⁷ Rehabilitation Department, Haihe Clinical School, Tianjin Medical University, Tianjin, China.

Abstract

Objective: This study aimed to analyze the cerebrospinal fluid (CSF) parameters affecting the outcomes of patients with tuberculous meningitis (TBM).

Methods: This is a multi-center, retrospective, cohort study involving 81 patients who were diagnosed with TBM and treated in Haihe Clinical College of Tianjin Medical University, Tianjin Medical University General Hospital, and General Hospital of Air Force PLA from January 2016 to December 2019. Baseline data, Glasgow Coma Scale (GCS) score, and clinical presentations of all patients were collected at admission. CSF samples were collected at 48 h, 1, 2, and 3 weeks after admission. CSF lactate, adenosine deaminase, chloride, protein, glucose levels and intracranial pressure were measured. After a follow-up of 16.14 ± 3.03 months, all patients were assessed using the modified Rankin Scale (mRS) and divided into good (mRS scores of 0-2 points) and poor outcome groups (mRS scores of 3-6 points). The differences in patients' baseline data, GCS score, clinical presentations, and levels of CSF parameters detected at 48 h, 1, 2, and 3 weeks after admission between two groups were compared. Statistically significant variables were added to the binary logistic regression model to identify the factors impacting the outcomes of patients with TBM. Receiver operating characteristic (ROC) curve was used to assess the predictive ability of the model.

Results: The CSF lactate level exhibited a decreasing trend within 3 weeks of admission in the two groups. For the within-group comparison, statistically significant differences in the lactate level was found in both groups between four different time points. A binary logistic regression model revealed that CSF lactate level at 48 h after admission, age, and GSC score on admission were independently associated with the outcomes of patients with TBM. ROC curve analysis showed that the area under the ROC curve (AUC) was 0.786 for the CSF lactate level (48 h), 0.814 for GCS score, and 0.764 for age.

Conclusion: High CSF lactate level at 48 h after admission is one of the important factors for poor outcomes in patients with TBM.

Keywords: cerebrospinal fluid examination; lactate level; prognostic factors; retrospective study; tuberculous meningitis.