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Submitted
August 31, 2026
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September 6, 2026
Published
September 30, 2026
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Abstract

Background. Distinguishing bacterial meningitis (BM) from aseptic meningitis (AM) in children with cerebrospinal fluid (CSF) pleocytosis remains a frequent clinical challenge in low-prevalence emergency settings. The conventional CSF panel (white-cell count [WBC], protein, CSF-to-blood glucose ratio) and prediction rules such as the Bacterial Meningitis Score (BMS) reduce, but do not eliminate, unnecessary admission and empirical antibiotic exposure. CSF lactate is generated by bacterial anaerobic metabolism, is independent of serum lactate, and is reported in adult meta-analysis to have pooled sensitivity of 0.93 and specificity of 0.96; locally calibrated paediatric data are needed.  


Objective. To determine the diagnostic accuracy of CSF lactate, CSF protein, CSF-to-blood glucose ratio, and CSF WBC count, alone and in combination, for discriminating BM from AM in children aged 1 month to 16 years presenting with CSF pleocytosis, against the reference standard of CSF culture or molecular bacterial detection with clinical adjudication.  


Patients and methods. A retrospective single-centre diagnostic-accuracy cohort study was conducted at [Tertiary Hospital] from January 2021 through December 2024 and reported in accordance with the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 statement. Children with a clinically indicated lumbar puncture, complete biomarker panel, and CSF pleocytosis were included. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) of each biomarker and of a combined logistic model were calculated.  


Results. Of 482 children screened, 348 with CSF pleocytosis formed the analytic cohort; 64 (18.4%) had BM. CSF lactate ≥ 3.0 mmol/L achieved a sensitivity of 93.8% (95% CI 84.7–98.4%) and specificity of 91.5% (87.6–94.4%); AUC 0.95 (0.92–0.98). A combined logistic model (CSF lactate, protein, glucose ratio, and WBC) reached an AUC of 0.97 (0.95–0.99).


Conclusions. CSF lactate ≥ 3.0 mmol/L was the most accurate single biomarker for paediatric BM and substantially improved a clinician-recognizable panel when combined with conventional CSF indices, supporting its routine measurement in centres evaluating children with CSF pleocytosis.

Keywords

bacterial meningitis cerebrospinal fluid CSF lactate children diagnostic accuracy Bacterial Meningitis Score STARD

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Copyright (c) 2026 Amjed Hassan Sahib* (Author)

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Amjed Hassan Sahib* (2026) “Diagnostic Accuracy of CSF Lactate and Allied Biomarkers for Paediatric Bacterial Meningitis”, Journal of Biomedicine and Biochemistry, 5(3), pp. 22–33. doi:10.57238/jbb.2026.7432.1178.
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Amjed Hassan Sahib* (2026) “Diagnostic Accuracy of CSF Lactate and Allied Biomarkers for Paediatric Bacterial Meningitis”, Journal of Biomedicine and Biochemistry, 5(3), pp. 22–33. doi:10.57238/jbb.2026.7432.1178.
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