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08.01.2019 | Original Communication

Adult CSF total protein upper reference limits should be age-partitioned and significantly higher than 0.45 g/L: a systematic review

verfasst von: Ari Breiner, David Moher, John Brooks, Wei Cheng, Harald Hegen, Florian Deisenhammer, Christopher R. McCudden, Pierre R. Bourque

Erschienen in: Journal of Neurology | Ausgabe 3/2019

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Abstract

Background

Cerebrospinal fluid total protein (CSF-TP) is measured in the diagnosis of a range of immune or infectious disorders of the nervous system. Most laboratories and the medical literature use an antiquated, age-independent upper limit of 0.45 g/L. Therefore, we performed a systematic review of reference studies in the medical literature, with the primary objective of determining the CSF total protein upper reference limit (URL). Secondary objectives were to assess the effects of age, gender, laboratory methods, and methodological quality.

Methods

A pre-planned and peer-reviewed electronic search strategy was used to search Ovid Medline and EMBASE for 1960–2017. All records underwent title/abstract review, and potentially relevant records underwent independent full-text review by two researchers. The remaining studies underwent quality assessment using a modification of the QUADAS2 revised tool. CSF-TP upper reference limits extracted from these studies were used to compute weighted means.

Results

Twenty-two articles were retained for qualitative analysis and 20 for quantitative analysis. The weighted average of CSF-TP URL was 0.55 g/L, in studies with high methodological quality. Studies that examined the effect of age reported consistent correlations with advancing age, and CSF-TP URL values incrementally exceeded 0.60 g/L after age 50. There were no meaningful differences according to gender, laboratory method, or quality assessment score.

Conclusions

There is concordance in available literature to recommend increasing CSF total protein upper reference limits, and to consider implementing age-adjusted values above 0.60 g/L starting at age 50. This information merits worldwide dissemination, to reduce the risk of over-diagnosis.

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Titel: Adult CSF total protein upper reference limits should be age-partitioned and significantly higher than 0.45 g/L: a systematic review
verfasst von: Ari Breiner
David Moher
John Brooks
Wei Cheng
Harald Hegen
Florian Deisenhammer
Christopher R. McCudden
Pierre R. Bourque
Publikationsdatum: 08.01.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology / Ausgabe 3/2019
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-09174-z

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Adult CSF total protein upper reference limits should be age-partitioned and significantly higher than 0.45 g/L: a systematic review