GIÁ TRỊ CỦA LACTAT DỊCH NÃO TỦY TRONG ĐÁNH GIÁ ĐÁP ỨNG ĐIỀU TRỊ VIÊM MÀNG NÃO MỦ Ở TRẺ EM

Abstract

Objectives: To determine the sensitivity and specificity of CSF lactate in predicting the treatment response after 48 hours of antibiotic use in children with bacterial meningitis. Subjects and and method: Pediatric patients hospitalized at Pediatric Center of Hue Central Hospital for 3 years (2016 - 2018) with diagnosis of bacterial meningitis. Diagnosis is based on analysis of cerebrospinal fluid.

Study design: Descriptive, prospective. Sample is taken by convenient sampling method.

Variables including: CSF leukocyte, protein, glucose, lactate level at initial and 48 hours after antibiotic use; treatment response (complete, not complete). Use the ROC curve to analyze the predictability value of CSF lactate for treatment response.

Results: 54 cases of bacterial meningitis (37 males, 17 females), median age 46 months. 35 cases met completely responded to antibiotics after 48 hours of treat ment. At the cutoff of initial lactate level > 7.7mmol/l could predict for incomplete response with a sensitivity of 75% and a specificity of 80%. CSF lactate level reducted in the group of completed response was significantly greater than that of the incompleted group (6.5 ± 1.7mmol/l vs 2.3 ± 1.6mmol/l, p < 0.001 ). At the cutoff of CSF lactate reducted level > 3mmol/l compared to the initial could predict for completed response with the sensitivity and specificity of 87% and 87.1%, respectively. The AUC of the lactatereducted level is 0.887 and greater than that for protein, glucose, and leukocyte. Conclusion: Initial CSF lactate concentrations and reduced levels after 48 hours of antibiotic treatment were very good at predicting the treatment response, and better than those of protein, glucose, and leukocyte respectively.