Clinical Study Of LCSS In Diagnosis And Differential Diagnosis With Tuberculous Meningitis Patients

Objective: To investigate the role of the Lancet consensus scoring system(LCSS)in the diagnosis and differential diagnosis of Tuberculous Meningitis(TBM),and to search for the value parameters identified between TBM and viral Meningitis,VM)patients.Methods: From January 2017 to December 2019,188 patients with intracranial infection presenting with fever and headache in department of Neurology,Affiliated Hospital of Qingdao University were retrospectively collected.The clinical history,signs,the first Cerebrospinal Fluid(CSF)test,cranial imaging,and related auxiliary tests that needed,and treatment results were collected.TBM,VM,Bacterial Meningitis(BM)and Cryptococcal Meningitis(CM)were diagnosed according to the diagnostic criteria and admitted by the criteria of case collection.LCSS score was performed for each patient.The contents of LCSS in TBM group and non-TBM group(N-TBM)(the other three groups of meningitis)were compared.The LCSS contents of TBM group and VM group were compared.Multivariate Logistic regression analysis was performed for the indexes with statistical differences in comparison.The CSF detection values of TBM group and VM group were compared,and multivariate Logistic regression analysis was performed on the indicators of statistical difference.Receiver operating curve(ROC)was used to evaluate the predictive value of CSF detection indicators in the identification with VM.Results: A total of 144 confirmed meningitis patients were collected,including 32 in the TBM group,with an average age of 33.1+11.59 years,17 males(53.1%),accounting for 22.2% of all meningitis patients.There were 94 cases of VM with an average age of 46.2+13.25 years and 54 cases of male,accounting for 57.5% and65.3% of all meningitis.There were no significant differences in age and sex ratio between the two groups(P =0.122,P =0.670).The LCSS score of each type of meningitis was 59.4% with ≥12 in TBM,40.6% with 6-11,and none with less than 6.In VM,6-11 points were the most common,accounting for 94.6%;In BM,6-11 points were also common,accounting for 83.3%.1.In the LCSS score between the TBM and N-TBM groups,the proportion of lymphocytes in CSF was greater than 50%,and positive of PCR of TB outside of intracranial were statistical difference between the two groups by(P =0.019,P =0.010).2.TBM and VM compared each index of LCSS score and found that: The three indexes of CSF protein > 1g/ L,glucose < 2.2mmol/L or 50% of blood glucose and tuberculosis PCR positive other than CSF in TBM group were higher than those in VM group,with statistically significant differences(P =0.041,P =0.024,P =0.021),while there were no statistically significant differences in other indexes between the two groups(P > 0.05).Logistic regression analysis of related indicators showed that only CSF was less than 2.2mmol/ L OR50% lower than blood glucose was statistically significant differences(OR 2.755,95%CI 1.124-6.754,P =0.027).3.Comparison of specific values of CSF between the two groups showed that CSF protein and ADA in TBM group were higher than those in VM group,while CSF sugar was lower than those in VM group,with statistical significance(P < 0.001,P =0.011,P < 0.001).The three factors with statistical differences were included in the multivariate Logistic regression analysis,and the results showed that: CSF protein(OR 2.616,95%CI 1.432-4.778,P =0.002)and CSF sugar(OR 0.523,95%CI 0.324-0.845,P =0.008)had independent predictive value,while ADA of CSF had no predictive value.4.ROC curve showed that CSF protein,CSF sugar and CSF combination protein and sugar had certain predictive value in distinguishing TBM from VM.The sensitivity and specificity of CSF protein were50% and 85%,with a threshold of 2.0g/ L.The sensitivity and specificity of CSF were84% and 49%,and the cut-off value was 3.0mmol/ L.The sensitivity of CSF protein combined with CSF sugar was 84% and the specificity increased to 60%.conclusions: 1.A high LCSS score is of value in the diagnosis of TBM,while a median score(6-11)is of little value in differentiating TBM from other common types of meningitis.2.LCSS scores of CSF protein greater than 1g/ L and CSF sugar less than 2.2mmol/L or 50% lower than blood glucose were of significance in the identification of TBM and VM.Among them,CSF sugar less than 2.2mmol/L or 50%lower than blood glucose had independent predictive value.3.In the differentiation between TBM and VM,CSF protein,CSF sugar and ADA of CSF were significant parameters.CSF protein above 2.0g/ L and CSF sugar below 3.0mmol/ L had independent predictive value,with a combined sensitivity of 84% and specificity of 60%.