The Detection Of Cerebrospinal Fluid Lactate Concentration In Children With Purulent Meningitis And The Relationship With Recent Prognosis

Objective To observe the changes of cerebrospinal fluid lactate concentration in children with purulent meningitis and investigate the relationship between it and the recent prognosis,for identifing the patients with high risk early and providing a reference for clinical practice.Methods The hospitalized children with purulent meningitis in the pediatric ward of the first affiliated hospital of Fujian medical university were included from Jan.2005 to July.2017,and all subjects were divided into better prognosis group and poor prognosis group on the basis of the Glasgow outcome score.The lactic acid contents of cerebrospinal fluid were detected by dry chemical colorimetry and compared between the two groups.Results 123 with purulent meningitis were enrolled.According to the standard of Glasgow outcome scores in discharge,85(69.1%)with cured or clinical improved were better prognosis group and 38(30.9%)were poor prognosis group,which them 34(27.6%)with neurological sequelae,and 4(3.3%)died during hospitalization.The lactic acid contents of cerebrospinal fluid(?x±S)were 2.027±1.173mmol/L and 3.668±2.900mmol/L in better prognosis group and poor prognosis group respectively,and the differences between the groups were statistically significant(P=0.002).Univariate analysis showed that the age,consciousness/coma,convulsions,complication,brain CT/MRI abnormalities,CRP,CSF protein and CSF sugar,were associated with poor prognosis of purulent meningitis.Covariance analysis were carried out with the lactic acid contents of cerebrospinal fluid as the dependent variable,prognosis as a fixed factor,and the statistically significant variables selected by univariate analysis as covariates.The results showed that the lactic acid contents of cerebrospinal fluid were affected significantly by the age(B=1.077,P=0.004),CSF protein(B=0.995,P=0.000),CSF sugar(B=-0.446,P=0.014)and it((?)±SE)were 2.178±0.182 mmol/L and 3.330±0.308 mmol/L in better prognosis group and poor prognosis group respectively after controlling the others affecting factors,and the difference between the groups were still statistically significant(P=0.005).Conclusions Compared with the better prognosis group,the lactic acid contents of cerebrospinal fluid in poor prognosis group was increased significantly,it could be provide guide for clinical diagnosis and treatment,and used as one of the indicators to identify the recent poor prognosis of childhood purulent meningitis,worthy of clinical popularization and application.