1. Normal cerebrospinal fluid protein and associated clinical characteristics in children with tuberculous meningitis
- Author
-
Chao Han, Yu He, Jun-Li Wang, Feng-Lian Yang, and Mao-Shui Wang
- Subjects
medicine.medical_specialty ,Adolescent ,Vomiting ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Gastroenterology ,Tuberculous meningitis ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Risk factor ,Child ,Children ,CSF albumin ,Cerebrospinal Fluid ,Retrospective Studies ,business.industry ,food and beverages ,Normal cerebrospinal fluid ,Cerebrospinal Fluid Proteins ,General Medicine ,medicine.disease ,cerebrospinal fluid protein ,Glucose ,risk factor ,tuberculous meningitis ,Tuberculosis, Meningeal ,Cerebrospinal fluid protein ,Multivariate Analysis ,Original Article ,business ,Research Article - Abstract
Background Although abnormal cerebrospinal fluid (CSF) protein can be used to predict the outcome of tuberculous meningitis (TBM) and diagnose TBM, normal CSF protein remains a concern in patients with TBM. This retrospective study aimed to assess the clinical characteristics associated with normal CSF protein, to resolve the dilemma of CSF protein in the management of childhood TBM. Methods Between January 2006 and December 2019, consecutive child patients (≤15 years old, a diagnosis of TBM, and tested for CSF protein) were included for analysis. CSF protein was tested on a chemistry analyzer using the pyrogallol red-molybdate method. Abnormal CSF protein was defined as >450 mg/L. Patient characteristics were collected from the electronic medical records. Then, characteristics associated with normal CSF protein were estimated in the study, using univariate and multivariate logistic regression analysis. Results A total of 125 children who met the criteria were enrolled during the study period. Twenty-nine patients had a normal CSF protein and 96 had an abnormal CSF protein. Multivariate analysis (Hosmer–Lemeshow goodness-of-fit test: χ2=2.486, df = 8, p = .962) revealed that vomiting (age- and sex-adjusted OR = 0.253, 95% CI: 0.091, 0.701; p = .008) and serum glucose (>5.08 mmol/L; age- and sex-adjusted OR = 0.119, 95% CI: 0.032, 0.443; p = .002) were associated with the normal CSF protein in childhood TBM. Conclusion In suspected childhood TBM, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required.KEY MESSAGESIn suspected childhood tuberculous meningitis, patients without vomiting or having low serum glucose are easy to present with normal CSF protein. Hence, when interpreting the level of CSF protein in children with such characteristics, a careful clinical assessment is required.
- Published
- 2021