Dear Lab Community,

Convincing evidence for the value of CSF lactate has been published by 
Straus et al. in JAMA 2006;296:2012 demonstrating that CSF lactate > 3.5 
mmmol/L accurately diagnosed bacterial meningitis (likelihood ratio 21) 
with lower values making the diagnosis less likely (LR 0.12). This 
parameter was better than WBC > 500/µL and CSF-blood glucose ratio.

Best regards,

Mike

Dr Michael Steiner
University of Rostock
Institute of Clinical Chemistry & Laboratory Medicine
D-18057 Rostock
GERMANY

Griffiths Paul (RQ3) BCH schrieb:
> Please see comments on this subject below from one of my colleagues.
>
> Paul Griffiths
> e-mail [log in to unmask]
>  
>
> Routinely we ask for CSF samples for lactate quantitation to be
> collected at room temperature into a fluoride-oxalate tube. They are
> usually analysed fairly soon after collection so stability is not an
> issue but I would expect the stability to be comparable to a centrifuged
> fluoride-oxalate blood sample for lactate assay.
> I am dubious (as is our Consultant Microbiologist!) that in practice CSF
> lactate is still used to distinguish bacterial from viral meningitis as
> an alternative to microbiological methods.
> One important comment from the Audit was the variability of reference
> ranges. I think it is important that ranges are established for CSF
> lactate using the method actually being used in the laboratory.
> In house we have an Olympus AU640 analyser method for CSF and blood
> lactate but blood lactates are also done on the blood gas analyser. We
> have some concerns about the comparability of longitudinal studies when
> monitoring changes in blood lactate using results from the blood gas
> analyser and the Olympus analyser. Also we have concerns in comparing
> CSF lactates with blood lactates when the blood lactate has only been
> done on the blood gas analyser.
> Has anyone any experience of this as a problem?
>
>
> George Gray
>
>
>  
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Lynch, Mark
> Sent: 03 October 2007 11:27
> To: [log in to unmask]
> Subject: CSF lactate measurement - sample requirements and stability
>
> The recently published National CSF audit (Ann Clin Biochem
> 2007;44:443-448) suggests that CSF lactate should be used to distinguish
> between bacterial and viral meningitis.
> For those laboratories already providing this service I was wondering
> what sample collection and storage requirements they recommend?
> i.e. How stable is CSF lactate? Do they transport on ice? Analyse within
> a particular time frame? Do they use stabilisers (e.g. NaF)? 
> In adddition what reference ranges and / or cut -offs are in use.
>
> The study referenced in the National audit (Intensive Care Med (1990)
> 16:196-200) indicated that the CSF was either analysed "immediately" or
> "stored at 4oC after addition of NaF and K Oxalate". Also, as mentioned
> in the audit report, the cut-off suggested was 4.2mmol/L.
>
> Regards
> Mark Lynch 
> Clinical Chemistry Laboratory
> Altnagelvin Hospital
> Londonderry 
> N Ireland
>
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