Clinical significance of lactate dehydrogenase level in cerebrospinal fluid in children with purulent meningitis
Objective To retrospectively study the level of lactate dehydrogenase(LDH)in cerebrospinal fluid(CSF),the pathogenic bacteria and the prognosis of children with purulent meningitis,and analyze the value of LDH level in predicting intracranial complications,in order to guide clinical diagnosis and treatment.Methods The clinical data of 213 children aged 0-14 years,who were admitted to Children's Hospital,Zhejiang University School of Medicine between January 2016 and December 2018,were retrospectively analyzed.The children were categorized into different groups based on the type of pathogenic bacteria and recent incidence of intracranial complications.Subsequently,the differences in LDH levels in CSF among the groups were analyzed.The value of LDH in predicting intracranial complications was assessed using ROC curve analysis.Results Out of the 213 children,90 had unknown pathogens and there were 123 tested positive for pathogen detection,including 59(48.0％)cases of Gram-positive(G+)bacteria and 64(52.0％)cases of Gram-negative(G-)bacteria.Among the children,122(57.3％)were successfully cured without any complications,while 91(42.7％)had complications,of whom 11(5.2％)died.The CSF-LDH level was significantly higher in children with intracranial complications than in those without complications(Z=-9.125,P＜0.001).The LDH level in the CSF was also statistically different in predicting the occurrence of intracranial complications(OR=1.004,95％CI 1.006-1.012,P＜0.001).The children in the death group had significantly higher LDH levels in their CSF compared to children with complications but survived(Z=-4.066,P＜0.001),with a significant difference in predicting the occurrence of death(OR=1.002,95％CI 1.001-1.004,P＜0.001).Furthermore,among children in the complication group,those aged ≥1 y had higher LDH level in their CSF compared to those aged＜3 m and 3 m to＜1y(Z=-2.405,-2.927,P＜0.05,respectively).There was no significant difference in LDH levels in the CSF between children with G+bacterial infections and those with G-bacterial infections(Z=-1.805,P＞0.05).Receiver operating characteristic(ROC)curves were drown based on LDH,PRO,and GLU concentrations in the CSF of children with or without complications during the acute phase,and the AUC values were 0.866,0.790,and 0.742,respectively.LDH level showed higher predictive efficiency for intracranial complications compared to PRO and GLU(Z=2.52 and 3.45,both P＜0.05),while PRO and GLU did not significantly differ in predictive efficiency(Z=1.22,P＞0.05).Conclusion The level of LDH in CSF of children with purulent meningitis at the early stage is related to the short-term prognosis.The higher the level,the higher the incidence of intracranial complications.
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