Adult CSF total protein: Higher upper reference limits should be considered worldwide. A web-based survey

Pierre R Bourque; Ari Breiner; David Moher; John Brooks; Harald Hegen; Florian Deisenhammer; Christopher R McCudden

doi:10.1016/j.jns.2018.10.033

Adult CSF total protein: Higher upper reference limits should be considered worldwide. A web-based survey

J Neurol Sci. 2019 Jan 15:396:48-51. doi: 10.1016/j.jns.2018.10.033. Epub 2018 Nov 3.

Authors

Pierre R Bourque¹, Ari Breiner², David Moher³, John Brooks⁴, Harald Hegen⁵, Florian Deisenhammer⁵, Christopher R McCudden⁶

Affiliations

¹ Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: pbourque@toh.ca.
² Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Canada.
⁴ Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
⁵ Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria.
⁶ Department of Pathology & Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ontario, Canada.

PMID: 30419367
DOI: 10.1016/j.jns.2018.10.033

Abstract

Background: The cerebrospinal fluid total protein level (CSF-TP) is commonly used as a potential marker of infectious or immune disease of the CNS and PNS. Recent laboratory reference studies indicate that the antiquated single upper reference limit of 0.45 g/L commonly used by hospital laboratories and widely quoted in medical literature is a significant underestimation.

Methods: We distributed worldwide a web-based survey comprised of three questions: 1. What is the CSF-TP upper limit used at your institution? 2. What is the source of this upper limit? 3. Do you adjust your upper limit according to age?

Results: A total of 473 unique responses were obtained from North America (37.5%), South America (5.5%), Europe (29.4%), Africa (4%), Asia (21.6%) and Oceania (1.7%). A strong preponderance (86.8%) of institutions reported an upper limit of 0.45 g/L or less. Only 4% reported making age-partitioned adjustments.

Conclusions: Worldwide, a strong majority of hospital laboratories presently use an underestimation of CSF-TP upper reference value, particularly for older adults. Recent well powered laboratory reference studies support higher values with age adjustment.

Keywords: Albuminocytologic dissociation; CIDP; Cerebrospinal fluid; Neuroimmunology.

MeSH terms

Adult
Cerebrospinal Fluid / chemistry*
Cerebrospinal Fluid Proteins / cerebrospinal fluid*
Cerebrospinal Fluid Proteins / standards*
Female
Global Health*
Health Surveys
Humans
Male
Reference Values

Substances

Cerebrospinal Fluid Proteins