What is the role of cerebrospinal fluid ferritin in the diagnosis of subarachnoid haemorrhage in computed tomography-negative patients?

Ann Clin Biochem 2008;45:189-192
© 2008 Association for Clinical Biochemistry


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Original Article

Ian D Watson 1,
Robert Beetham 2 ,
Michael N Fahie-Wilson 3,
Ian B Holbrook 4 and
Daniel M O’Connell 1

1 Department of Neurobiochemistry, The Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK;
2 Department of Clinical Biochemistry, North Bristol NHS Trust, Frenchay Hospital, Bristol BS16 1LE, UK;
3 Department of Biochemistry, Southend Hospital, Westcliff on Sea, Essex SS0 0RY, UK;
4 Department of Clinical Biochemistry, York Hospital, York YO31 8HE, UK

Corresponding author: Dr Robert Beetham. Email: robert.beetham{at}nbt.nhs.uk

Background: Spectrophotometry of cerebrospinal fluid (CSF) for bilirubinis the recommended method for investigation in suspected casesof subarachnoid haemorrhage (SAH), when a computed tomography(CT) of the head is negative for blood. There is a potentialneed for a simpler alternative. Measurement of CSF ferritinmight fulfil this need.

Method: We have measured ferritin in the CSF from 252 patients withsuspected SAH who were negative on a CT of the head for blood,recruited on a consecutive intention to recruit basis from fourcentres. CSF spectrophotometry was performed on all samples.A positive outcome was taken as an aneurysm found on angiographythat was treated or a discharge diagnosis of non-aneurysmalSAH.

Results: A final diagnosis of aneurysmal SAH was made in six patients, an arteriovenous malformation in one and non-aneurysmal SAH in nine. Receiver operating characteristic (ROC) analysis showed that at 6.4 µg/L, sensitivity, specificity, positive and negative predictive values were 1.0, 0.48, 0.12 and 1.0, respectively. At 12 µg/L, these values were 0.81, 0.91, 0.38 and 0.98,respectively.

Conclusions: At an appropriate negative predictive value (1.0) for a rule-outtest, ferritin has too low a specificity to function as a stand-alonetest and we cannot recommend it as an initial screen to be followedby spectrophotometry.

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