Prognostic Efficacy of Cerebrospinal Fluid Gamma Glutamyl Transpeptidase in Pyogenic and Tuberculous Meningitis – A Cross- Sectional Study

Abstract

Background and objectives ABSTRACT Gamma glutamyl transpeptidase was measured serially in cerebrospinal fluid in 40 cases of meningitis with the aim to find out its prognostic significance in cases of pyogenic and tuberculous meningitis. Methods The enzymatic activity was measured serially on day one and five in cerebrospinal fluid in 40 cases of meningitis consisting of 22 cases of pyogenic and 18 cases of tuberculous meningitis and 10 age and sex matched healthy control. The clinical details including the level of consciousness and neurological deficits were correlated with the enzymatic activity and prognosis. Results The levels of cerebrospinal fluid gamma glutamyl transpeptidase were significantly elevated in all the cases ( 75.05 ± 38.27 IU/L ) of meningitis as compared to controls ( 5.60 ± 1.81 IU/L ) . The activity was significantly higher in pyogenic than in tuberculous meningitis. The maximum elevation in activity of gamma glutamyl transpeptidase was seen on the first day thereafter the activity declined in the majority of cases who had shown clinical improvement. However in 10 cases ( seven pyogenic meningitis, three tuberculous meningitis ) , the enzymatic activity on day five, persistently remained high. All these 10 cases died. Further, the basal enzymatic activity in all these 10 cases that died ( 110.20 ± 24.14 IU/L ) was higher compared to those who survived ( 63.33 ± 34.94 IU/L ) . IX Conclusions and interpretation It is concluded that cerebrospinal fluid gamma glutamyl transpeptidase was significantly elevated in cases of meningitis. It was not possible to differentiate the type of meningitis on the basis of enzymatic activity in any of them. However, it was possible to predict prognosis because higher basal activity and persistent high level were associated with poor prognosis.