Cerebrospinal Fluid Analysis in Patients with Post-neurosurgical Procedures: Meningitis vs. Non-meningitis

Background & Objective: Cerebrospinal fluid (CSF) analysis is helpful in the diagnosis of infections of the central nervous system (CNS), especially after neurosurgical procedures. This study aimed to evaluate the diagnostic value of CSF markers for diagnosis of post-neurosurgical meningitis (PNM). Methods: Patients with neurosurgical procedures whose CSF was obtained for any reason (meningitis and non-meningitis) during ۲۰۲۰ and ۲۰۲۲, at Imam Khomeini Hospital Complex, Tehran, Iran, were included. Serum and CSF lactate dehydrogenase (LDH), glucose, protein, white blood cells (WBC), red blood cells (RBC), and CSF/serum glucose and LDH ratio were compared between the patients who were diagnosed with PNM and those without meningitis. Results: A total of ۱۱۵ patients were included, of whom ۲۳ patients were diagnosed with PNM and ۹۲ with non-meningitis. No significant differences were observed in patients’ age, gender, and underlying diseases between the two groups. Findings showed a significantly (P=۰.۰۲۹) lower level of the mean CSF glucose (۵۹.۵ mg/dL ±۳۳.۹) in patients with meningitis than in patients without meningitis (۷۶.۸ mg/dL ± ۳۷.۵). The mean CSF/serum glucose ratio was ۴۳.۷% in the meningitis group and ۵۶.۳% in the non-meningitis group (P=۰.۰۰۸). The mean WBC count and neutrophil dominance were significantly higher in the meningitis group. No significant differences were observed in CSF LDH, Protein, and RBC between the two groups. Conclusion: A CSF glucose level of less than ۶۰ mg/dL, a CSF/serum glucose ratio of less than ۰.۴۴, and a higher CSF WBC and neutrophil count can help diagnose PNM.

Keywords:

Cerebrospinal fluid (CSF) analysis , CSF glucose , CSF leukocyte count , Post-neurosurgical meningitis