Diagnostic accuracy of urine test strips for CSF analysis: high sensitivity in detecting blood, low sensitivity but high specificity in detecting inflammation
- 1Hannover Medical School, Department for Neurology
Abstract
Background: Rapid cerebrospinal fluid (CSF) analysis is crucial for diagnosing and treating time-critical neurological diseases. However, thorough laboratory diagnostics are time-intensive or often unavailable in resource-limited settings. Urine test strips (UTS) may provide a simple bedside alternative, but evidence remains limited and largely restricted to single manufacturers. This study evaluated the diagnostic performance of UTS for CSF analysis and compared different manufacturers.
Methods: In this prospective study, 285 CSF samples from patients with different neurological diseases were analyzed using UTS from five manufacturers. Strip results for leukocytes, erythrocytes, protein, and glucose were compared across manufacturers and against laboratory measurements. Diagnostic accuracy for detecting blood in CSF, pleocytosis, and for differentiating infectious from non-infectious conditions was assessed.
Results: For erythrocyte detection, the UTS showed high sensitivity (86–95%) and negative predictive value (NPV, 92–97%). In contrast, for CSF pleocytosis, specificity and positive predictive value (PPV) were high (100%), whereas sensitivity was low (11%). UTS underestimated low leukocyte counts and showed variable performance for protein detection. For differentiating infectious from non-infectious conditions, leukocytes and glucose demonstrated high specificity and PPV. Combining parameters (≥ 2/3 positive: leukocytes, protein, glucose) yielded consistently high specificity (98%) and PPV (80–85%), but low sensitivity (13–15%) and NPV (63%). No relevant differences between manufacturers were observed.
Conclusion: UTS provide a rapid, low-cost bedside tool for initial CSF assessment, with particular strength in reliably excluding blood contamination. In contrast, their utility for detecting inflammatory or infectious conditions is limited due to low sensitivity. Therefore, while UTS may support early bedside decision-making, they cannot replace standard laboratory diagnostics.
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BibTeX
@article{albers2026diagnostic,
title = {{Diagnostic accuracy of urine test strips for CSF analysis: high sensitivity in detecting blood, low sensitivity but high specificity in detecting inflammation}},
author = {Lina Marie Albers and Franz Felix Konen and Erda Atakan and Konstantin Fritz Jendretzky and Sandra Nay and Lea Grote-Levi and Kurt-Wolfram Sühs and Thomas Skripuletz and Philipp Schwenkenbecher},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1893760},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1893760/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic accuracy of urine test strips for CSF analysis: high sensitivity in detecting blood, low sensitivity but high specificity in detecting inflammation
AU - Lina Marie Albers
AU - Franz Felix Konen
AU - Erda Atakan
AU - Konstantin Fritz Jendretzky
AU - Sandra Nay
AU - Lea Grote-Levi
AU - Kurt-Wolfram Sühs
AU - Thomas Skripuletz
AU - Philipp Schwenkenbecher
PY - 2026
DA - 2026/10/26
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1893760
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1893760/full
AB - Background: Rapid cerebrospinal fluid (CSF) analysis is crucial for diagnosing and treating time-critical neurological diseases. However, thorough laboratory diagnostics are time-intensive or often unavailable in resource-limited settings. Urine test strips (UTS) may provide a simple bedside alternative, but evidence remains limited and largely restricted to single manufacturers. This study evaluated the diagnostic performance of UTS for CSF analysis and compared different manufacturers. Methods: In this prospective study, 285 CSF samples from patients with different neurological diseases were analyzed using UTS from five manufacturers. Strip results for leukocytes, erythrocytes, protein, and glucose were compared across manufacturers and against laboratory measurements. Diagnostic accuracy for detecting blood in CSF, pleocytosis, and for differentiating infectious from non-infectious conditions was assessed. Results: For erythrocyte detection, the UTS showed high sensitivity (86–95%) and negative predictive value (NPV, 92–97%). In contrast, for CSF pleocytosis, specificity and positive predictive value (PPV) were high (100%), whereas sensitivity was low (11%). UTS underestimated low leukocyte counts and showed variable performance for protein detection. For differentiating infectious from non-infectious conditions, leukocytes and glucose demonstrated high specificity and PPV. Combining parameters (≥ 2/3 positive: leukocytes, protein, glucose) yielded consistently high specificity (98%) and PPV (80–85%), but low sensitivity (13–15%) and NPV (63%). No relevant differences between manufacturers were observed. Conclusion: UTS provide a rapid, low-cost bedside tool for initial CSF assessment, with particular strength in reliably excluding blood contamination. In contrast, their utility for detecting inflammatory or infectious conditions is limited due to low sensitivity. Therefore, while UTS may support early bedside decision-making, they cannot replace standard laboratory diagnostics.
SN - 1664-2295
ER -