Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Vershinin, V.
Laboratory diagnostics of rhinoliquorrhea and its evaluation
Studium für die Gleichwertigkeit; Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2021. pp. 57
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Haindl Michaela Tanja
- Hochmeister Sonja
- Altmetrics:
- Abstract:
- Abstract Objective Rhinoliquorrhea is a clinical condition, where cerebrospinal fluid (CSF) passes through the nose via a pathological connection to the cranial cavity in the area of anterior or middle cranial fossa. From etiological point of view, traumatic, iatrogenic and spontaneous CSF fistulas can be distinguished. One of the most dangerous related complications is bacterial meningitis, thus an accurate and fast diagnosis is important. For this purpose, radiological and laboratory methods are used. However, diagnostics can be quite challenging, since a small defect size is a limitation to radiological methods. Accordingly, nasal discharge analysis to examine CSF specific compounds seems to be a suitable prospective method. Among all CSF proteins, ß- trace protein (BTP) is most interesting. It is a protein with impressively high intrathecal fractions, CSF/Serum ratio and shows relatively high concentrations in CSF. However, recommended cut-off values in the literature vary widely between 0.244 and 6 mg/l. The main aim of this diploma thesis is to improve the diagnostic accuracy of determining CSF leakage and new evaluation of existing cut-off values in nasal discharge. A second aim was the retrospective calculation of specificity and sensitivity using NPV and PPV. Methods BTP concentrations in ventricular CSF (V-CSF) and lumbar CSF (L-CSF), (n = 24 each), and in nasal discharge from known healthy volunteers (n = 17) with admixture of gradually prediluted (pure, 2, 3 and 4 Fold) V- or L-CSF was measured via nephelometry. In order to evaluate BTP as a suitable marker, BTP concentrations in serum (n=17), nasal discharge for determining BTP concentration of healthy population (n = 188) and nasal discharge of operative examined patients (n = 75) were statistically analyzed. Since some groups revealed to be not normally distributed (evaluated via Kolmogorov-Smirnov test), non-parametric tests were preferred. For determining the significance between groups, Kruskal-Wallis and Mann-Whitney-U-Test were used; for investigation of correlations, Spearman’s correlation coefficient was calculated. BTP cut-off value in nasal discharge was determined via ROC Curve. Sensitivity, specificity, positive and negative predictive values were calculated via cross tables. Results There was a significant difference (p < 0.001) detectable between the means of V-CSF (10.94 mg/l) and L-CSF (25.69 mg/l) BTP concentrations, as well as serum (0.52 mg/l) and nasal discharge (0.29 mg/l) values. An inverse correlation between prediluted samples was detected via Spearman’s correlation coefficient (p < 0.001). The ROC curve (Figure 16) represented an AUC of 0.765 with a significance of p < 0.001. Additionally, a sensitivity of 100% with a PPV of 75.7% and a specificity of 22.7% with a NPV of 100% could be described (p < 0.001). Conclusion The results of this study suggest the acceptance of the cut-off value of 1.3 mg/l. We conclude that BTP seems to be a promising laboratory marker of even minor rhinoliquorrhea, which however requires further evaluation with consideration of possible limitations. Certain patient related features like bacterial meningitis, impaired renal function and multiple skull injuries can lead to BTP value changes in the respective sample. Thus, evaluation must always been done considering the clinical context.