Relationship between cerebrospinal fluid lactate level and craniocerebral MRI findings and prognosis of tuberculous meningitis

doi:10.19871/j.cnki.xfcrbzz.2025.06.010

Abstract

Abstract: Objective To explore the correlation between lactate level of cerebrospinal fluid (CSF) and cranial magnetic resonance imaging (MRI) manifestations and prognosis of tuberculous meningitis (TBM) patients, so as to provide a basis for diagnosis and prognosis of TBM. Method This study adopted a retrospective analysis method. A total of 48 patients with TBM admitted to Chongqing Dazu District People's Hospital from January 2020 to February 2023 were included and followed up for 6 months. The adverse clinical outcome was death or severe disability 6 months after admission. Patients with death or severe disability were included in the adverse outcome group (n=16), and patients with a Glasgow outcome scale (GOS) of 4 or 5 were included in the good outcome group (n=32). All patients underwent MRI examination, and CSF lactate levels were analyzed by automatic biochemical analyzer. Result Compared with the good outcome group, the CSF lactate level in the bad outcome group was significantly higher [(4.07±2.42)mmol/L vs (6.59±3.44)mmol/L, t=2.946, P=0.005]. Receiver operating characteristic curve analysis showed that CSF lactate level predicted 6-month clinical outcome of TBM patients with an area under the curve of 0.838 (95% CI: 0.688-0.988) at the optimal cut-off value (4.36 mmol/L), the sensitivity and specificity of the prediction were 87.5% and 84.4%, respectively. Multivariate Logistics analysis determined that CSF lactate level >4.36 mmol/L was an independent risk factor for death in TBM patients within 6 months. TBM patients with CSF lactate level >4.36 mmol/L were more likely to have MRI findings of basal ganglia region, thalamus, cerebellum cerebral infarction and hydrocephalus (P<0.05). Conclusion TBM patients with a CSF lactate level >4.36 mmol/L of admission are more likely to present with cerebral infarction and hydrocephalus findings on MRI. This indicator is also an independent risk factor for mortality within 6 months in TBM patients, and serves as an important indicator for assessing the prognosis of TBM patients.

Key words: Cerebrospinal fluid lactate, Tuberculous meningitis, Magnetic resonance imaging, Imaging manifestations, Prognosis

CLC Number:

R52
R529.3

Huang Zhiqiang, Wu Shaoquan, Zhou Bangjian, Tian Yongpan, Wu Jixiang, Peng Yunhang. Relationship between cerebrospinal fluid lactate level and craniocerebral MRI findings and prognosis of tuberculous meningitis[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(6): 63-69.

References

[1] 李媛媛, 谢晶晶, 李树涛, 等. 2024年WHO全球结核病报告:全球与中国关键数据分析[J/CD]. 新发传染病电子杂志, 2024, 9(6):92-98.
[2] 凌再芹, 孔海丽, 朱峰, 等. IL-33和ADA水平在结核性脑膜炎病程中的动态变化及意义[J]. 重庆医学, 2021, 50(12):2089-2092, 2096.
[3] CAO X, YANG Q, ZHOU X, et al.Cerebral Infarction and Evan's Ratio on MRI Affect the Severity and Prognosis of Tuberculosis Meningitis Patients[J]. Diagnostics (Basel), 2022, 12(5):1264-1276.
[4] 张玲, 杨启纲, 程宏伟, 等. 脑脊液乳酸及降钙素原对诊断神经外科术后细菌性脑膜/脑室炎的应用探讨[J]. 安徽医科大学学报, 2019, 54(5):762-766.
[5] 严智, 刘海波, 赵天全, 等. 脑脊液乳酸在动脉瘤性蛛网膜下腔出血术后转归中的预测价值研究[J]. 中华神经医学杂志, 2020, 19(5):483-487.
[6] WANG N, ZHANG SN, XING RJ, et al.Cerebrospinal fluid lactate level in aquaporin-4 antibody positive neuromyelitis optica spectrum disorders: a hint on differential diagnosis and possible immunopathogenesis[J]. Mult Scler Relat Disord, 2021, 47: 102629-102641.
[7] DE ALMEIDA SM, KUSSEN GB, COGO LL, et al.Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis[J]. Diagnosis(Berl), 2022, 10(2):130-139.
[8] PARIHAR R, SHUKLA R, BAISHYA B, et al.NMR based CSF metabolomics in tuberculous meningitis: correlation with clinical and MRI findings[J]. Metab Brain Dis, 2022, 37(3):773-785.
[9] WANG MS, ZHAO M, LIU XJ.Risk factors for poor outcome in childhood tuberculous meningitis[J]. Sci Rep, 2021, 11(1):8654-8659.
[10] THWAITES G, FISHER M, HEMINGWAY C, et al.British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children[J]. J Infect, 2009, 59(3): 167-87.
[11] LUCAS MJ, BROUWER MC, VAN DER ENDE A, et al. Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score[J]. Neurol Neuroimmunol Neuroinflamm, 2014, 1(1):e9-e15.
[12] SORIA J, METCALF T, MORI N, et al.Mortality in hospitalized patients with tuberculous meningitis[J]. BMC Infect Dis, 2019, 19(1):9-16.
[13] YADAV D, SINGH O, JUNEJA D, et al.Role of cerebrospinal fluid lactate in diagnosing meningitis in critically ill patients[J]. World J Crit Care Med, 2023,12(1):1-9.
[14] STEPHANI C, CHOI AHK, MOERER O.Point-of-care detection of lactate in cerebrospinal fluid[J]. Intensive Care Med Exp, 2021, 9(1):18-27.
[15] LOZANO A, FRANCHI F, SEASTRES RJ, et al.Glucose and Lactate Concentrations in Cerebrospinal Fluid After Traumatic Brain Injury[J]. J Neurosurg Anesthesiol, 2020,32(2):162-169.
[16] TOMALKA J, SHARMA A, SMITH AGC, et al.Combined cerebrospinal fluid metabolomic and cytokine profiling in tuberculosis meningitis reveals robust and prolonged changes in immunometabolic networks[J]. Tuberculosis (Edinb), 2024,144:102462-102481.
[17] WANG C, FORSMAN LD, WANG S, et al.The diagnostic performance of GeneXpert MTB/RIF in tuberculosis meningitis: A multicentre accuracy study[J]. Diagn Microbiol Infect Dis, 2024, 109(3):116277-116289.
[18] 郭海志, 李跃, 谢飞, 等. 脑脊液糖/乳酸、脑脊液糖/血糖比值对颅内感染的诊断价值[J]. 郑州大学学报(医学版), 2019, 54(6):887-890.
[19] DE ALMEIDA SM, BARROS NC, PETTERLE R, et al.Comparison of cerebrospinal fluid lactate with physical, cytological, and other biochemical characteristics as prognostic factors in acute bacterial meningitis[J]. Arq Neuropsiquiatr, 2019, 77(12):871-880.
[20] DIAN S, HERMAWAN R, VAN LAARHOVEN A, et al.Brain MRI findings in relation to clinical characteristics and outcome of tuberculous meningitis[J]. PLoS One, 2020, 15(11): e0241974.
[21] NUWAGIRA E, HUPPLER HULLSIEK K, JJUNJU S, et al.Diagnostic and Prognostic Value of Cerebrospinal Fluid Lactate and Glucose in HIV-Associated Tuberculosis Meningitis[J]. Microbiol Spectr, 2022, 10(4): e0161822-e0161831.
[22] XIONG XY, PAN XR, LUO XX, et al.Astrocyte-derived lactate aggravates brain injury of ischemic stroke in mice by promoting the formation of protein lactylation[J]. Theranostics, 2024, 14(11):4297-4317.
[23] HARAHAP MIR, SOETIKNO RD, ANWARY F.Relationship between neutrophil count in cerebrospinal fluid and cerebral infarct appearance in head MRI on tuberculous meningitis patients[J]. Eur J Radiol Open, 2022, 10:100469-100473.