INTRODUCTION: Outcomes following bacterial meningitis are significantly improved by adjunctive treatment with corticosteroids. However, little is known about the levels and significance of intrathecal endogenous cortisol. The aim of this study was to assess cortisol as a biological and diagnostic marker in patients with bacterial meningitis. METHODS: Forty-seven consecutive patients with bacterial meningitis and no prior treatment were evaluated. For comparison, a group of 37 patients with aseptic meningitis and a group of 13 healthy control individuals were included. RESULTS: The mean age of the bacterial meningitis patients was 42 years, and the mean Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores on admission were 12, 13 and 4, respectively. Altogether, 40 patients (85%) were admitted to the intensive care unit, with a median (interquartile range) length of stay of 8 (4 to 15) days. A bacterial etiology was confirmed in 35 patients (74%). The median (interquartile range) cortisol concentration in cerebrospinal fluid (CSF) was 133 (59 to 278) nmol/l. CSF cortisol concentrations were positively correlated with serum cortisol levels (r = 0.587, P < 0.001). Furthermore, CSF cortisol levels correlated with Acute Physiology and Chronic Health Evaluation II score (r = 0.763, P < 0.001), Sequential Organ Failure Assessment score (r = 0.650, P < 0.001), Glasgow Coma Scale score (r = -0.547, P < 0.001) and CSF lactate levels (r = 0.734, P < 0.001). CSF cortisol was only weakly associated with intrathecal levels of IL-6 (r = 0.331, P = 0.02) and IL-8 (r = 0.296, P < 0.05). CSF cortisol levels in bacterial and aseptic meningitis significantly differed (P < 0.001). The CSF cortisol concentration of 46.1 nmol/l was found to be the optimal cutoff value for diagnosis of bacterial meningitis. CONCLUSION: CSF cortisol levels in patients with bacterial meningitis are highly elevated and correlate with disease severity. Moreover, our findings also suggest that intrathecal cortisol may serve as a valuable marker in discriminating between bacterial and aseptic meningitis.

3rd Department of Infectious and Tropical Diseases of 1st Faculty of Medicine Charles University Prague Budinova 2 CZ 180 81 Prague Czech Republic

000      

00000naa 2200000 a 4500

001      

bmc10026790

003      

CZ-PrNML

005      

20130813104432.0

008      

101019s2007 xxk e eng||

009      

AR

040    __

$a ABA008 $b cze $c ABA008 $d ABA008 $e AACR2

041    0_

$a eng

044    __

$a xxk

100    1_

$a Holub, Michal $7 xx0018615

245    10

$a Cortisol levels in cerebrospinal fluid correlate with severity and bacterial origin of meningitis / $c M. Holub, O. Beran, O. Dzupova, J. Hnykova, Z. Lacinova, J. Prihodova, B. Prochazka, M. Helcl

314    __

$a 3rd Department of Infectious and Tropical Diseases of First Faculty of Medicine, Charles University in Prague, Budinova 2, CZ-180 81, Prague, Czech Republic. michal.holub@lf1.cuni.cz

520    9_

$a INTRODUCTION: Outcomes following bacterial meningitis are significantly improved by adjunctive treatment with corticosteroids. However, little is known about the levels and significance of intrathecal endogenous cortisol. The aim of this study was to assess cortisol as a biological and diagnostic marker in patients with bacterial meningitis. METHODS: Forty-seven consecutive patients with bacterial meningitis and no prior treatment were evaluated. For comparison, a group of 37 patients with aseptic meningitis and a group of 13 healthy control individuals were included. RESULTS: The mean age of the bacterial meningitis patients was 42 years, and the mean Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores on admission were 12, 13 and 4, respectively. Altogether, 40 patients (85%) were admitted to the intensive care unit, with a median (interquartile range) length of stay of 8 (4 to 15) days. A bacterial etiology was confirmed in 35 patients (74%). The median (interquartile range) cortisol concentration in cerebrospinal fluid (CSF) was 133 (59 to 278) nmol/l. CSF cortisol concentrations were positively correlated with serum cortisol levels (r = 0.587, P < 0.001). Furthermore, CSF cortisol levels correlated with Acute Physiology and Chronic Health Evaluation II score (r = 0.763, P < 0.001), Sequential Organ Failure Assessment score (r = 0.650, P < 0.001), Glasgow Coma Scale score (r = -0.547, P < 0.001) and CSF lactate levels (r = 0.734, P < 0.001). CSF cortisol was only weakly associated with intrathecal levels of IL-6 (r = 0.331, P = 0.02) and IL-8 (r = 0.296, P < 0.05). CSF cortisol levels in bacterial and aseptic meningitis significantly differed (P < 0.001). The CSF cortisol concentration of 46.1 nmol/l was found to be the optimal cutoff value for diagnosis of bacterial meningitis. CONCLUSION: CSF cortisol levels in patients with bacterial meningitis are highly elevated and correlate with disease severity. Moreover, our findings also suggest that intrathecal cortisol may serve as a valuable marker in discriminating between bacterial and aseptic meningitis.

650    _2

$a APACHE $7 D018806

650    _2

$a dospělí $7 D000328

650    _2

$a biologické markery $x mok mozkomíšní $7 D015415

650    _2

$a mozkomíšní mok $x cytologie $x chemie $7 D002555

650    _2

$a cytokiny $x mok mozkomíšní $7 D016207

650    _2

$a diferenciální diagnóza $7 D003937

650    _2

$a ženské pohlaví $7 D005260

650    _2

$a Glasgowská stupnice kómat $7 D015600

650    _2

$a hemofilové infekce $x diagnóza $x mok mozkomíšní $7 D006192

650    _2

$a Haemophilus influenzae $7 D006193

650    _2

$a lidé $7 D006801

650    _2

$a hydrokortison $x mok mozkomíšní $7 D006854

650    _2

$a mužské pohlaví $7 D008297

650    _2

$a meningitida aseptická $x diagnóza $7 D008582

650    _2

$a meningitida bakteriální $x diagnóza $x mikrobiologie $x mok mozkomíšní $7 D016920

650    _2

$a pneumokokové infekce $x diagnóza $x mok mozkomíšní $7 D011008

650    _2

$a ROC křivka $7 D012372

650    _2

$a financování organizované $7 D005381

655    _2

$a hodnotící studie $7 D023362

700    1_

$a Beran, Ondřej $7 xx0106657

700    1_

$a Džupová, Olga $7 xx0080446

700    1_

$a Hnyková, Jarmila. $7 _AN054842

700    1_

$a Lacinová, Zdeňka $7 xx0062138

700    1_

$a Příhodová, Jana $7 xx0104799

700    1_

$a Procházka, Bohumír, $d 1953-2017 $7 xx0075077

700    1_

$a Helcl, Miroslav $7 xx0073815

773    0_

$w MED00006603 $t Critical care $g Roč. 11, č. 2 (2007), s. R41 $x 1364-8535

910    __

$a ABA008 $b x $y 7

990    __

$a 20101102082058 $b ABA008

991    __

$a 20130813104940 $b ABA008

999    __

$a ok $b bmc $g 801895 $s 666655

BAS    __

$a 3

BMC    __

$a 2007 $b 11 $c 2 $d R41 $m Critical care $n Critical Care (London, England) $x MED00006603

GRA    __

$a NR8014 $p MZ0

LZP    __

$a 2010-B3/vtme