Research

Cortisol levels in cerebrospinal fluid correlate with severity and bacterial origin of meningitis

Michal Holub^1,2 , Ondřej Beran^1,2 , Olga Džupová^2,3 , Jarmila Hnyková¹ , Zdenka Lacinová⁴ , Jana Příhodová² , Bohumír Procházka⁵ and Miroslav Helcl²

¹3rd Department of Infectious and Tropical Diseases of First Faculty of Medicine, Charles University in Prague, Budínova 2, CZ-180 81, Prague, Czech Republic

²Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, CZ-180 81, Prague, Czech Republic

³Department of Infectious Diseases of Third Faculty of Medicine, Charles University in Prague, Budínova 2, CZ-180 81, Prague, Czech Republic

⁴3rd Medical Department – Department of Endocrinology and Metabolism of the First Faculty of Medicine, Charles University in Prague, U nemocnice 1, CZ-128 08, Prague, Czech Republic

⁵Department of Biostatistics, National Institute of Health, Šrobárova 48, CZ-100 42, Prague, Czech Republic

author email corresponding author email

Critical Care 2007, 11:R41doi:10.1186/cc5729

Published:	27 March 2007

Abstract

Introduction

Outcomes following bacterial meningitis are significantly improved by adjunctive treatment with corticosteroids. However, little is known about the levels and significance of intrathecal endogenous cortisol. The aim of this study was to assess cortisol as a biological and diagnostic marker in patients with bacterial meningitis.

Methods

Forty-seven consecutive patients with bacterial meningitis and no prior treatment were evaluated. For comparison, a group of 37 patients with aseptic meningitis and a group of 13 healthy control individuals were included.

Results

The mean age of the bacterial meningitis patients was 42 years, and the mean Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores on admission were 12, 13 and 4, respectively. Altogether, 40 patients (85%) were admitted to the intensive care unit, with a median (interquartile range) length of stay of 8 (4 to 15) days. A bacterial etiology was confirmed in 35 patients (74%). The median (interquartile range) cortisol concentration in cerebrospinal fluid (CSF) was 133 (59 to 278) nmol/l. CSF cortisol concentrations were positively correlated with serum cortisol levels (r = 0.587, P < 0.001). Furthermore, CSF cortisol levels correlated with Acute Physiology and Chronic Health Evaluation II score (r = 0.763, P < 0.001), Sequential Organ Failure Assessment score (r = 0.650, P < 0.001), Glasgow Coma Scale score (r = -0.547, P < 0.001) and CSF lactate levels (r = 0.734, P < 0.001). CSF cortisol was only weakly associated with intrathecal levels of IL-6 (r = 0.331, P = 0.02) and IL-8 (r = 0.296, P < 0.05). CSF cortisol levels in bacterial and aseptic meningitis significantly differed (P < 0.001). The CSF cortisol concentration of 46.1 nmol/l was found to be the optimal cutoff value for diagnosis of bacterial meningitis.

Conclusion

CSF cortisol levels in patients with bacterial meningitis are highly elevated and correlate with disease severity. Moreover, our findings also suggest that intrathecal cortisol may serve as a valuable marker in discriminating between bacterial and aseptic meningitis.