Diagnosis of postoperative meningitis using CSF lactate

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All India Institute of Medical Sciences

Health & Medicine Business

Postoperative Meningitis Diagnosing using CSF Lactate Shashwat Mishra , Deepak Agrawal, BS Sharma Dept of Neurosurgery, All India Institute of Medical Sciences New Delhi-110029

INTRODUCTION ,[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnose early and reliably! ,[object Object],[object Object],[object Object],[object Object]

Recommended criteria ,[object Object],[object Object],[object Object]

Actual Scenario ,[object Object],[object Object],[object Object]

Materials and methods ,[object Object],[object Object],[object Object],[object Object]

Materials & Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CSF Sampling frequency ,[object Object],[object Object],[object Object],[object Object]

Materials & Methods ,[object Object],[object Object]

Materials & Methods ,[object Object],[object Object],[object Object],[object Object],[object Object]

Observations ,[object Object],[object Object]

Observations ,[object Object],39 14 25 TOTAL 5 2 3 More than 50 yrs 22 8 14 18-50 yrs 12 4 8 Less than 18 yrs TOTAL CONTROL CASE AGEGROUP

Observations ,[object Object],39 14 25 TOTAL 7 1 6 FEMALE 32 13 19 MALE TOTAL CONTROL CASE SEX

Observations ,[object Object],10 0 10 Did not Subside 18 3 15 Subsided 28 3 25 PRESENT TOTAL CONTROL CASE FEVER

Observations ,[object Object],39 29 10 Total 14 14 0 Control 25 15 10 (40 %) Case Total Culture - Culture + Category

RESULTS ,[object Object],0.04 43 312 Day 5/7 0.556 278 371 Day 3 0.547 405 609 Day 1 Mean Corr WBC/mm3 2 tailed significance CONTROL CASE DAY OF SAMPLING

Mean CSF: Blood glucose ratio RESULTS .06 .61 .48 Day 5/7 .002 .62 .38 Day 3 .001 .68 .32 Day 1 Mean CSF:Blood Glucose 2 tailed significance CONTROL CASE DAY OF SAMPLING

RESULTS Mean CSF lactate .211 3.571 4.436 Day 5/7 .000 3.157 5.076 Day 3 .001 3.257 5.56 Day 1 Mean CSF Lactate values 2 tailed significance CONTROL CASE DAY OF SAMPLING

RESULTS Mean CSF lactate trends correlated with culture positivity

RESULTS Mean CSF lactate trends correlated with subsidence of fever .005 3.5 5.7 Day 5/7 .42 5.1 4.9 Day 3 .997 5.6 5.6 Day 1 Mean CSF Lactate values 2 tailed significance Responded Didn’t respond DAY OF SAMPLING

RESULTS Combination of CSF lactate>5.0 and Sugar ratio < 0.4 Senstivity = 100% , specificity = 60% CULTURE - 25 15 10 Total 9 9 0 Combination - 16 6 10 Combination + TOTAL CULTURE +

RESULTS Conventional CSF analysis (CSF WBC >500/cumm) Senstivity = 27% , specificity = 50% CULTURE - 25 10 15 Total 16 5 11 WBC - 9 5 4 WBC + TOTAL CULTURE +

Discussion ,[object Object],[object Object],[object Object]

CONCLUSIONS ,[object Object],[object Object],[object Object]

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