Document Detail


Rapid, accurate and non-invasive detection of cerebrospinal fluid leakage using combined determination of beta-trace protein in secretion and serum.
MedLine Citation:
PMID:  15563887     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: beta-Trace protein (Btp) has been proposed as a valuable marker of cerebrospinal fluid (CSF) leakage overcoming the drawbacks of beta-2-transferrin (B-2Tr) determination. However, there is still controversy about the appropriate cut-offs to be used (range 0.35-6 mg/L). The aim of the study was to evaluate cut-offs of Btp determination for detection CSF leakage. Further, we assessed whether the Btp secretion to serum ratio (Btp-sec/ser-ratio) would add diagnostic value. METHODS: Prospective study in patients with suspected CSF leakage. Quantitative determination of Btp in secretion and serum (Dade-Behring) and qualitative measurement of B-2-Tr in secretion and serum. Results were assessed in view of clinical data. Cut-offs and diagnostic characteristics were determined by ROC analysis. RESULTS: A total of 176 samples were assessed originating from 105 patients. In 43 samples CSF leakage could be confirmed. Sensitivity of B-2-Tr was 84%, specificity amounted to 100%. The area under the curve (AUC) for Btp-measurement in secretion was 0.98. At a cut-off of 0.68 mg/L, sensitivity was 100% and specificity 91%. At a cut-off of 1.11 mg/L, the specificity was 100% with a sensitivity of 93%. The Btp-sec/ser-ratio has an AUC of 0.99. Combining a 0.68 mg/L cut-off in secretion with a Btp-sec/ser-ratio cut-off of 4.9 reveals a sensitivity of 99% and a specificity of 100%. CONCLUSIONS: Btp is a rapid and accurate marker for the presence of CSF leakage. Combining measurement of Btp in secretion together with determination of the Btp-sec/ser-ratio enhances the diagnostic characteristics of the Btp assay. Determination of Btp in both serum and secretion is thus recommended.
Authors:
Lorenz Risch; Ivan Lisec; Markus Jutzi; Michael Podvinec; Hans Landolt; Andreas R Huber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinica chimica acta; international journal of clinical chemistry     Volume:  351     ISSN:  0009-8981     ISO Abbreviation:  Clin. Chim. Acta     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2004-11-26     Completed Date:  2005-04-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1302422     Medline TA:  Clin Chim Acta     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  169-76     Citation Subset:  IM    
Affiliation:
Clinical Decision Making Research Unit, Vorarlberg Institute of Vascular Investigation and Treatment, Academic Teaching Hospital, Feldkirch, Austria.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biological Markers
Cerebrospinal Fluid / physiology*
Craniocerebral Trauma / cerebrospinal fluid*
Ear / injuries
Female
Humans
Intramolecular Oxidoreductases / blood,  cerebrospinal fluid*
Lipocalins
Male
Middle Aged
Nephelometry and Turbidimetry
Neurosurgical Procedures
Nose / injuries
Prospective Studies
ROC Curve
Skull Fractures / cerebrospinal fluid,  radiography
Transferrin / cerebrospinal fluid
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Lipocalins; 11096-37-0/Transferrin; EC 5.3.-/Intramolecular Oxidoreductases; EC 5.3.99.2/prostaglandin R2 D-isomerase

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