Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis

Objective: To evaluate the diagnostic accuracy of routine blood examinations and Cerebrospinal Fluid (CSF) lactate level for Post-neurosurgical Bacterial Meningitis (PBM) at a large sample-size of post-neurosurgical patients. Methods: The diagnostic accuracies of routine blood examinations and CSF lactate level to distinguish between PAM and PBM were evaluated with the values of the Area Under the Curve of the Receiver Operating Characteristic (AUC(-ROC)) by retrospectively analyzing the datasets of post-neurosurgical patients in the clinical information databases. Results: The diagnostic accuracy of routine blood examinations was relatively low (AUC(-ROC) < 0.7). The CSF lactate level achieved rather high diagnostic accuracy (AUC(-ROC) = 0.891; CI 95%, 0.852-0.922). The variables of patient age, operation duration, surgical diagnosis and postoperative days (the interval days between the neurosurgery and examinations) were shown to affect the diagnostic accuracy of these examinations. The variables were integrated with routine blood examinations and CSF lactate level by Fisher discriminant analysis to improve their diagnostic accuracy. As a result, the diagnostic accuracy of blood examinations and CSF lactate level was significantly improved with an AUC(-ROC) value = 0.760 (CI 95%, 0.737-0.782) and 0.921 (CI 95%, 0.887-0.948) respectively. Conclusions: The PBM diagnostic accuracy of routine blood examinations was relatively low, whereas the accuracy of CSF lactate level was high. Some variables that are involved in the incidence of PBM can also affect the diagnostic accuracy for PBM. Taking into account the effects of these variables significantly improves the diagnostic accuracies of routine blood examinations and CSF lactate level. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.