DOI 10.1515/cclm-2013-0953 Clin Chem Lab Med 2014; 52(7): 1009–1017
Petr Kelbich*, Aleš Hejčl, Iva Selke Krulichová, Jan Procházka, Eva Hanuljaková, Jitka Peruthová, Martina Koudelková, Martin Sameš and Jan Krejsek
Coefficient of energy balance, a new parameter for basic investigation of the cerebrospinal fluid Abstract Background: The concentrations of glucose and lactate in cerebrospinal fluid (CSF) provide important information about energy metabolism in the CSF compartment. To improve our understanding of this information we introduced a new parameter resulting from a formula for calculating the fictitious production of adenosine triphosphate, i.e., the coefficient of energy balance (KEB). Methods: We evaluated cytology, the concentrations of glucose and lactate and the KEB in the CSF of 948 patients, who were divided into five groups. For statistical analysis we used the Kruskal-Wallis test with post-hoc analysis using the Dunn method and multinomial regression analysis. We determined the specificities and sensitivities of the cytological pictures and the KEB. Results: A KEB > 28.0 corresponded to normal energy metabolism in the CSF. A KEB 10.0, increased to 100.0% (Table 3). In the group of patients with purulent inflammation of the CNS of bacterial etiology (P), we found a statistically significant increase in the number of leukocytes and the concentration of lactate and a decreased concentration of glucose in the CSF as well as decreased values of Qglu and KEB compared to the three groups of patients above (C, A, S). The highest KEB value was 5.20 (Table 1). In this group of patients (P) we did not find a normal cytological picture of the CSF in any case. In 176 cases (95.7%) we found N pleiocytosis, while in 8 cases (4.3%) we found monocytic pleiocytosis (Table 2). In this group of patients (P), the prevailing cytological picture was N pleiocytosis with a sensitivity of 95.7% and a specificity of 95.5%; after adding the KEB > 10.0 criterion, the specificity increased to 100.0% (Table 3). In the rare group of patients with severe inflammation and an oxidative burst of macrophages and macrophagocytic production of NO with intracellular bacteria or yeasts in its pathogenesis (M), we found a statistically increased number of leukocytes in the CSF compared with groups C and A and at the same time a statistically significant decrease in the number of leukocytes in the CSF compared to group P. Further, in this group of patients we found a significantly lower concentration of glucose in the CSF and significantly decreased KEB values compared to groups C, A and S. We found no statistically significant differences in the numbers of leukocytes between groups M and S. We also did not find any statistically significant difference in the concentrations of glucose in the CSF, the values of Qglu and KEB or the concentrations of lactate between groups M and P. We found the highest KEB value to be 8.80 (Table 1). We also did not find a normal cytological picture of the CSF in this group (M). In one case (6.7%) we found
Table 2 Overview of the cytological pictures of the CSF in the investigated groups of patients. Number of patients (frequency) Normal finding N oligocytosis Ly oligocytosis Mo oligocytosis N pleiocytosis Ly pleiocytosis Mo pleiocytosis
C (n = 176) 111 (63.1%) 0 (0.0%) 21 (11.9%) 44 (25.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
A (n = 356)
33 (9.3%) 0 (0.0%) 134 (37.6%) 40 (11.2%) 0 (0.0%) 130 (36.5%) 19 (5.3%)
S (n = 217)
0 (0.0%) 1 (0.5%) 1 (0.5%) 0 (0.0%) 34 (15.7%) 166 (76.4%) 15 (6.9%)
P (n = 184)
0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 176 (95.7%) 0 (0.0%) 8 (4.3%)
M (n = 15)
0 (0.0%) 0 (0.0%) 1 (6.7%) 0 (0.0%) 0 (0.0%) 11 (73.3%) 3 (20.0%)
C, A, S, P, M, groups of patients; n, number of patients; Ly oligocytosis/pleiocytosis, lymphocytic oligocytosis/pleiocytosis; Mo oligocytosis/ pleiocytosis, monocytic oligocytosis/pleiocytosis; N oligocytosis/pleiocytosis, oligocytosis/pleiocytosis of neutrophil granulocytes.
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Kelbich et al.: Evaluation of energy relationships in the cerebrospinal fluid 1013 Table 3 Overview of the specificities and sensitivities of only the cytological pictures of the CSF and of the cytological pictures of the CSF together with the levels of the energy parameter KEB.
A (n = 356)
S (n = 217)
P (n = 184)
M (n = 15)
Mononuclear oligocytosis + KEB > 10.0 N pleiocytosis N pleiocytosis + KEB > 10.0 N pleiocytosis + KEB 10.0 Mononuclear pleiocytosis + KEB
Petr Kelbich*, Aleš Hejčl, Iva Selke Krulichová, Jan Procházka, Eva Hanuljaková, Jitka Peruthová, Martina Koudelková, Martin Sameš and Jan Krejsek
Coefficient of energy balance, a new parameter for basic investigation of the cerebrospinal fluid Abstract Background: The concentrations of glucose and lactate in cerebrospinal fluid (CSF) provide important information about energy metabolism in the CSF compartment. To improve our understanding of this information we introduced a new parameter resulting from a formula for calculating the fictitious production of adenosine triphosphate, i.e., the coefficient of energy balance (KEB). Methods: We evaluated cytology, the concentrations of glucose and lactate and the KEB in the CSF of 948 patients, who were divided into five groups. For statistical analysis we used the Kruskal-Wallis test with post-hoc analysis using the Dunn method and multinomial regression analysis. We determined the specificities and sensitivities of the cytological pictures and the KEB. Results: A KEB > 28.0 corresponded to normal energy metabolism in the CSF. A KEB 10.0, increased to 100.0% (Table 3). In the group of patients with purulent inflammation of the CNS of bacterial etiology (P), we found a statistically significant increase in the number of leukocytes and the concentration of lactate and a decreased concentration of glucose in the CSF as well as decreased values of Qglu and KEB compared to the three groups of patients above (C, A, S). The highest KEB value was 5.20 (Table 1). In this group of patients (P) we did not find a normal cytological picture of the CSF in any case. In 176 cases (95.7%) we found N pleiocytosis, while in 8 cases (4.3%) we found monocytic pleiocytosis (Table 2). In this group of patients (P), the prevailing cytological picture was N pleiocytosis with a sensitivity of 95.7% and a specificity of 95.5%; after adding the KEB > 10.0 criterion, the specificity increased to 100.0% (Table 3). In the rare group of patients with severe inflammation and an oxidative burst of macrophages and macrophagocytic production of NO with intracellular bacteria or yeasts in its pathogenesis (M), we found a statistically increased number of leukocytes in the CSF compared with groups C and A and at the same time a statistically significant decrease in the number of leukocytes in the CSF compared to group P. Further, in this group of patients we found a significantly lower concentration of glucose in the CSF and significantly decreased KEB values compared to groups C, A and S. We found no statistically significant differences in the numbers of leukocytes between groups M and S. We also did not find any statistically significant difference in the concentrations of glucose in the CSF, the values of Qglu and KEB or the concentrations of lactate between groups M and P. We found the highest KEB value to be 8.80 (Table 1). We also did not find a normal cytological picture of the CSF in this group (M). In one case (6.7%) we found
Table 2 Overview of the cytological pictures of the CSF in the investigated groups of patients. Number of patients (frequency) Normal finding N oligocytosis Ly oligocytosis Mo oligocytosis N pleiocytosis Ly pleiocytosis Mo pleiocytosis
C (n = 176) 111 (63.1%) 0 (0.0%) 21 (11.9%) 44 (25.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
A (n = 356)
33 (9.3%) 0 (0.0%) 134 (37.6%) 40 (11.2%) 0 (0.0%) 130 (36.5%) 19 (5.3%)
S (n = 217)
0 (0.0%) 1 (0.5%) 1 (0.5%) 0 (0.0%) 34 (15.7%) 166 (76.4%) 15 (6.9%)
P (n = 184)
0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 176 (95.7%) 0 (0.0%) 8 (4.3%)
M (n = 15)
0 (0.0%) 0 (0.0%) 1 (6.7%) 0 (0.0%) 0 (0.0%) 11 (73.3%) 3 (20.0%)
C, A, S, P, M, groups of patients; n, number of patients; Ly oligocytosis/pleiocytosis, lymphocytic oligocytosis/pleiocytosis; Mo oligocytosis/ pleiocytosis, monocytic oligocytosis/pleiocytosis; N oligocytosis/pleiocytosis, oligocytosis/pleiocytosis of neutrophil granulocytes.
Brought to you by | University of Washington Libraries Authenticated Download Date | 12/1/14 3:58 PM
Kelbich et al.: Evaluation of energy relationships in the cerebrospinal fluid 1013 Table 3 Overview of the specificities and sensitivities of only the cytological pictures of the CSF and of the cytological pictures of the CSF together with the levels of the energy parameter KEB.
A (n = 356)
S (n = 217)
P (n = 184)
M (n = 15)
Mononuclear oligocytosis + KEB > 10.0 N pleiocytosis N pleiocytosis + KEB > 10.0 N pleiocytosis + KEB 10.0 Mononuclear pleiocytosis + KEB
