6 research outputs found
Multicenter Testing of the Rapid Quantification of Radical Oxygen Species in Cerebrospinal Fluid to Diagnose Bacterial Meningitis
<div><p>Purpose</p><p>Meningitis is a serious concern after traumatic brain injury (TBI) or neurosurgery. This study tested the level of reactive oxygen species (ROS) in cerebrospinal fluid (CSF) to diagnose meningitis in febrile patients several days after trauma or surgery.</p><p>Methods</p><p>Febrile patients (temperature > 38°C) after TBI or neurosurgery were included prospectively. ROS were measured in CSF within 4 hours after sampling using luminescence in the basal state and after cell stimulation with phorbol 12-myristate 13-acetate (PMA). The study was conducted in a single-center cohort 1 (n = 54, training cohort) and then in a multicenter cohort 2 (n = 136, testing cohort) in the Intensive Care and Neurosurgery departments of two teaching hospitals. The performance of the ROS test was compared with classical CSF criteria, and a diagnostic decision for meningitis was made by two blinded experts.</p><p>Results</p><p>The production of ROS was higher in the CSF of meningitis patients than in non-infected CSF, both in the basal state and after PMA stimulation. In cohort 1, ROS production was associated with a diagnosis of meningitis with an AUC of 0.814 (95% confidence interval (CI) [0.684–0.820]) for steady-state and 0.818 (95% CI [0.655–0.821]) for PMA-activated conditions. The best threshold value obtained in cohort 1 was tested in cohort 2 and showed high negative predictive values and low negative likelihood ratios of 0.94 and 0.36 in the basal state, respectively, and 0.96 and 0.24 after PMA stimulation, respectively.</p><p>Conclusion</p><p>The ROS test in CSF appeared suitable for eliminating a diagnosis of bacterial meningitis.</p></div
ROC curves associated with a diagnosis of meningitis.
<p>ROC curves associated with a diagnosis of meningitis in cohort 1 after PMA stimulation (solid line) and in the basal state (dotted line).</p
Clinical context and characteristics of the two cohorts.
<p>Quantitative parameters are expressed as median values (min to max).</p><p>Postop: postoperative, Trauma: traumatic brain injury, EVD: external ventricular drainage, WBC: white blood cells, CSF: cerebrospinal fluid, PMN: polymorphonuclear cells, RBC: red blood cells, W/R: white blood cells/red blood cells, ATB: antibiotics.</p><p>Clinical context and characteristics of the two cohorts.</p
Performance of ROS measurements.
<p>The performance of ROS measurements (basal state) in the total cohort of 190 patients according to sampling by LP or EVD, the presence or absence of previous antibiotic administration and a diagnosis of meningitis by the experts or biological criteria (i.e., CSF cells > 100/mm<sup>3</sup> and positive microbiological results [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0128286#pone.0128286.ref005" target="_blank">5</a>]).</p
Clinical and biological characteristics in cohorts according to the diagnosis of meningitis.
<p>Results are expressed in median value (min to max); statistics were produced using the Wilcoxon test.</p><p>WBC: white blood cells, CSF: cerebrospinal fluid, PMN: polymorphonuclear cells, RBC: red blood cells, W/R: white blood cells/red blood cells, ROS: radical oxygen species, AUC: area under the curve, PMA: phorbol 12-myristate 13-acetate.</p><p>Clinical and biological characteristics in cohorts according to the diagnosis of meningitis.</p
ROS production after PMA stimulation.
<p>ROS production after PMA stimulation (A) and in the basal state (B) in cohorts 1 and 2 according to an expert diagnosis of meningitis.</p