title: Cerebrospinal fluid neopterin analysis in neuropediatric patients: establishment of a new cut off-value for the identification of inflammatory-immune mediated processes.
abstract: OBJECTIVE
  A high level of cerebrospinal fluid (CSF) neopterin is a marker of central nervous system inflammatory-immune mediated processes. We aimed to assess data from 606 neuropediatric patients, describing the clinical and biochemical features of those neurological disorders presenting CSF neopterin values above a new cut-off value that was defined in our laboratory.
  
  
  METHODS
  To establish the new CSF neopterin cut-off value, we studied two groups of patients: Group 1 comprised 68 patients with meningoencephalitis, and Group 2 comprised 52 children with a confirmed peripheral infection and no central nervous system involvement. We studied 606 CSF samples from neuropediatric patients who were classified into 3 groups: genetic diagnosis (A), acquired/unknown etiologic neurologic diseases (B) and inflammatory-immune mediated processes (C).
  
  
  RESULTS
  The CSF neopterin cut-off value was 61 nmol/L. Out of 606 cases, 56 presented a CSF neopterin level above this value. Group C had significantly higher CSF neopterin, protein and leukocyte values than the other groups. Sixteen of twenty-three patients in this group had a CSF neopterin level above the cut-off, whereas three and seven patients presented increased leukocyte and protein values, respectively. A significant association was found among CSF neopterin, proteins and leukocytes in the 606 patients. White matter disturbances were associated with high CSF neopterin concentrations.
  
  
  CONCLUSIONS
  Although children with inflammatory-immune mediated processes presented higher CSF neopterin values, patients with other neurological disorders also showed increased CSF neopterin concentrations. These results stress the importance of CSF neopterin analysis for the identification of inflammatory-immune mediated processes.
authors.affiliation: Clinical Biochemistry and Neuropediatrc Departments, University Hospital Sant Joan de Déu, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Molero-Luis
authors.affiliation: Intensive Pediatric Care Unit Service, University Hospital Saint Joan de Déu, Barcelona, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Fernández-Ureña
authors.affiliation: Intensive Pediatric Care Unit Service, University Hospital Saint Joan de Déu, Barcelona, Spain.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Jordán
authors.affiliation: Clinical Biochemistry and Neuropediatrc Departments, University Hospital Sant Joan de Déu, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Serrano
authors.affiliation: Clinical Biochemistry and Neuropediatrc Departments, University Hospital Sant Joan de Déu, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Ormazábal
authors.affiliation: Clinical Biochemistry and Neuropediatrc Departments, University Hospital Sant Joan de Déu, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Àngels
authors.initials: À
authors.lastname: Garcia-Cazorla
authors.affiliation: Clinical Biochemistry and Neuropediatrc Departments, University Hospital Sant Joan de Déu, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Artuch
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000150:complications; D008297:Male; D019798:Neopterin / Q000134:cerebrospinal fluid*; D009422:Nervous System Diseases / Q000134:cerebrospinal fluid* / Q000150:complications / Q000276:immunology*; D012372:ROC Curve
chemical_list: D019798:Neopterin