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Báo cáo y học: " Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. | Huy et al. Critical Care 2010 14 R240 http ccforum.eom content 14 6 R240 KS CRITICAL CARE RESEARCH Open Access Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis a systemic review and meta-analysis Nguyen T Huy1 Nguyen TH Thao2 Doan TN Diep2 3 Mihoko Kikuchi1 4 Javier Zamora5 Kenji Hirayama1 4 6 Abstract Introduction Making a differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical problem. The utility of a cerebrospinal fluid CSF lactate assay for this purpose has been debated and is not yet routinely clinically performed. To adequately evaluate this assay a systematic review and meta-analysis of studies of the CSF lactate concentration as a marker for both bacterial meningitis and aseptic meningitis was performed. Methods Electronic searches in PubMed Scopus the MEDION database and the Cochrane Library were conducted to identify relevant articles published before March 2009. A manual search of reference lists from selected articles was also conducted. Two reviewers independently selected relevant articles and extracted data on study characteristics quality and accuracy. Results Twenty-five articles were identified that met the eligibility criteria. Diagnostic odds ratios were considerably homogenous Chi-square P 0.1009 I2 27.6 and the homogeneity was further confirmed by a Galbraith plot and meta-regression analysis using several covariates. The symmetrical summary receiver-operator characteristic curve SROC fitted using the Moses-Shapiro-Littenberg method was positioned near the upper left corner of the SROC curve. The Q value and area under the curve were 0.9451 and 0.9840 respectively indicating excellent accuracy. The diagnostic accuracy of the CSF lactate concentration was higher than those of other four conventional markers CSF glucose CSF plasma glucose quotient CSF protein and CSF total number of leukocytes using a head to head meta-analysis of the 25 included studies. .