SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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L Risch1 , I Lisec2 , M Podvinec2 , I.A.F.M. Heijnen3 , A.R. Huber3

1Department of Internal Medicine, Academic teaching hospital, Feldkirch, Austria, 2Department of Otorinolaryngology, Kantonsspital, Aarau, Switzerland, 3Department of Laboratory Medicine, Kantonsspital, Aarau, Switzerland

Background: Detection of CSF leakage is of importance as early treatment can prevent devastating consequences. Beta-2- Transferrin (B2-Tr) showed good diagnostic characteristics in detecting CSF leakage but is laborsome to determine with delayed availability of results. Recently, beta trace protein (Btp) has been proposed as a marker of CSF leakage.
Aim: To assess the characteristics of a nephelometric Btp assay in detecting CSF leakage.
Methods: Prospective study in patients with suspected CSF leakage. Materials included ear or nose tamponades/secretions and were tested in parallel for B2-Tr and Btp (Dade, US). In most patients, serum measurement of Btp was also done. Results of Btp and B2-Tr were assessed in view of clinical data.
Results: 176 samples were assessed originating from 104 patients. 133 samples originated from patients without clinical evidence of CSF leakage. Of these, all had a negative B2-Tr result, and all had a Btp < 1.1mg/dL (median 0.3mg/dL, interquartile range, IQR, 0.11-0.51 mg/dL) with a median ratio of Btp in secretion and serum (Btp sec/ser) of 0.54 (min. 0.09. max 4.8, IQR 0.27-1.1). 43 samples originated from sites with CSF leakage: B2-Tr was positive in 36 samples (sens. 82%), whereas Btp had a median value of 11 mg/dL (IQR 3.6-20.1). According to the cut-off proposed by Arrer et al. (1.31mg/dL), 3 samples were false negative, resulting in a sens. of 93%. The sens. of B2-Tr and Btp was not significantly different (p=0.19). The Btp sec/ser ratio in patients with CSF leakage was 32 (min 1, max 210, IQR 8.8-54.1) and higher than in patients without CSF leakage ( < 0.001). The 3 Btp false negative samples had secretion to serum ratios of 6.9, 7, and 1.0. ROC analysis of Btp-results revealed an AUC of 0.98.
Conclusion: Btp is a rapid and accurate marker for the presence of CSF leakage. The Btp sec/ser ratio helps to identify additional cases with Btp below the cut-off. Determination of BtP in both serum and secretion is thus recommended.


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