Abstract
Cerebrospinal fluid (CSF) lactate assay has been a subject of research since 1925. A systematic review by Huy and colleagues in the previous issue of Critical Care summarizes data from 25 studies evaluating the role of CSF lactate in the differential diagnosis between acute bacterial and aseptic meningitis. The authors concluded that CSF lactate is a good single indicator and a better marker compared with conventional markers. But concerns remain because of poor quality of included studies, lack of proper 'gold standard', and limited applicability. More studies with a rigorous design are needed to determine definitively whether CSF lactate assay is a reliable and valid marker to distinguish between acute bacterial meningitis and aseptic meningitis.
Highlights
Cerebrospinal fluid (CSF) lactate assay has been a subject of research since 1925
The chance-corrected agreement between the reviewers was very high for study selection, the same was not reported for data extraction and quality assessment
Huy and colleagues used well-established criteria to assess the quality of the selected studies, and examined and explored heterogeneity using standard methods and summarized the results using a summary receiver operator characteristic (SROC) curve
Summary
Cerebrospinal fluid (CSF) lactate assay has been a subject of research since 1925. A systematic review by Huy and colleagues in the previous issue of Critical Care summarizes data from 25 studies evaluating the role of CSF lactate in the differential diagnosis between acute bacterial and aseptic meningitis. Independent reviewers for selection of studies, data extraction, and quality assessment. The chance-corrected agreement (kappa = 0.898) between the reviewers was very high for study selection, the same was not reported for data extraction and quality assessment. Huy and colleagues used well-established criteria to assess the quality of the selected studies, and examined and explored heterogeneity using standard methods and summarized the results using a summary receiver operator characteristic (SROC) curve.
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