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Peer-reviewedCC BY-NC 4.0Korean Journal of Neurotrauma

Bedside Feasibility and Preliminary Diagnostic Performance of the Point-of-Care Combined Lactate–Glucose Ratio for Detecting Cerebrospinal Fluid Infection in Neurosurgical Patients: A Pilot Study

  • Adnan Qadri1
  • Ishtiyaq Hussain2
  • Mehreen Syed Gurcoo3
  • Duha Wani4
  • Rafiya Gull5
5 affiliations
  1. 1Department of Anesthesia, Paras Health Srinagar, Srinagar, India .
  2. 2Department of Neurosurgery, Government Medical College (GMC), Srinagar, India .
  3. 3Department of Microbiology, Government Medical College (GMC), Anantnag, India .
  4. 4Department of Medicine, Government Medical College (GMC), Srinagar, India .
  5. 5Department of Anesthesia, Government Medical College (GMC), Srinagar, India .
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Abstract

Objective: Diagnosing cerebrospinal fluid (CSF) infection in neurosurgical patients with ventricular devices is challenging due to nonspecific clinical features, prior antibiotic exposure, and delayed microbiological confirmation. Rapid bedside biomarkers that can reliably support early diagnosis are therefore needed. This study explored the preliminary diagnostic performance and feasibility of the combined lactate–glucose ratio (CLGR), measured using a point-of-care blood gas analyzer, for early detection of CSF infection in a neurosurgical intensive care unit (ICU) population.

Methods: In this prospective, single-center pilot study reported per Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015, 62 neurosurgical ICU patients were screened; 48 enrolled, 47 analyzed. CSF lactate/glucose were measured using point-of-care arterial blood gas analyzer (blinded to culture); CLGR calculated. Culture positivity was the reference standard.

Results: Eighteen (37.5%) had culture-positive infection. Median CLGR was higher in infected cases (14.48 vs. 6.35, p<0.0001). At CLGR ≥10, sensitivity was 83.3%, specificity 82.8% (area under the curve, 0.868). Results were available in 4 minutes (interquartile range, 3–5) with a 0% failure rate.

Conclusion: The CLGR demonstrates strong potential as a rapid, feasible, and reliable bedside biomarker for diagnosing CSF infection in neurosurgical patients. Point-of-care CLGR measurement may serve as a rapid, adjunctive bedside tool for initial risk stratification, complementing conventional CSF analysis while awaiting definitive microbiological results.

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Cite

BibTeXRIS
BibTeX
@article{qadri2026bedside,
  title = {{Bedside Feasibility and Preliminary Diagnostic Performance of the Point-of-Care Combined Lactate–Glucose Ratio for Detecting Cerebrospinal Fluid Infection in Neurosurgical Patients: A Pilot Study}},
  author = {Adnan Qadri and Ishtiyaq Hussain and Mehreen Syed Gurcoo and Duha Wani and Rafiya Gull},
  journal = {Korean Journal of Neurotrauma},
  year = {2026},
  month = sep,
  doi = {10.13004/kjnt.2026.22.e38},
  url = {https://doi.org/10.13004/kjnt.2026.22.e38},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Bedside Feasibility and Preliminary Diagnostic Performance of the Point-of-Care Combined Lactate–Glucose Ratio for Detecting Cerebrospinal Fluid Infection in Neurosurgical Patients: A Pilot Study
AU  - Adnan Qadri
AU  - Ishtiyaq Hussain
AU  - Mehreen Syed Gurcoo
AU  - Duha Wani
AU  - Rafiya Gull
PY  - 2026
DA  - 2026/09/14
JO  - Korean Journal of Neurotrauma
DO  - 10.13004/kjnt.2026.22.e38
UR  - https://doi.org/10.13004/kjnt.2026.22.e38
AB  - Objective: Diagnosing cerebrospinal fluid (CSF) infection in neurosurgical patients with ventricular devices is challenging due to nonspecific clinical features, prior antibiotic exposure, and delayed microbiological confirmation. Rapid bedside biomarkers that can reliably support early diagnosis are therefore needed. This study explored the preliminary diagnostic performance and feasibility of the combined lactate–glucose ratio (CLGR), measured using a point-of-care blood gas analyzer, for early detection of CSF infection in a neurosurgical intensive care unit (ICU) population.  Methods: In this prospective, single-center pilot study reported per Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015, 62 neurosurgical ICU patients were screened; 48 enrolled, 47 analyzed. CSF lactate/glucose were measured using point-of-care arterial blood gas analyzer (blinded to culture); CLGR calculated. Culture positivity was the reference standard.  Results: Eighteen (37.5%) had culture-positive infection. Median CLGR was higher in infected cases (14.48 vs. 6.35, p<0.0001). At CLGR ≥10, sensitivity was 83.3%, specificity 82.8% (area under the curve, 0.868). Results were available in 4 minutes (interquartile range, 3–5) with a 0% failure rate.  Conclusion: The CLGR demonstrates strong potential as a rapid, feasible, and reliable bedside biomarker for diagnosing CSF infection in neurosurgical patients. Point-of-care CLGR measurement may serve as a rapid, adjunctive bedside tool for initial risk stratification, complementing conventional CSF analysis while awaiting definitive microbiological results.
SN  - 2234-8999
SN  - 2288-2243
ER  -