Procoagulant and fibrinolytic activity in cerebrospinal fluid from adults with bacterial meningitis

SummaryObjectivesThis study investigated levels of coagulation and fibrinolysis factors in cerebrospinal fluid (CSF) from adults with bacterial meningitis in relation to development of brain infarction.MethodsCSF was collected from 92 adults with community-acquired bacterial meningitis, who participated in the prospective Dutch Meningitis Cohort Study; 8 patients with viral meningitis and 9 healthy control subjects. Levels of proteins involved in the coagulation cascade were determined by means of immunoassays.ResultsBacterial meningitis was accompanied by local activation of coagulation, as shown by significantly higher CSF soluble tissue factor (P < 0.001) and prothrombin fragment F1+2 concentrations (P < 0.001) as compared to viral meningitis patients and controls. This was accompanied by a significantly higher D-dimer formation (P < 0.001). In addition, in bacterial meningitis fibrinolysis was attenuated, since CSF plasminogen activator inhibitor (PAI)-1 levels were significantly higher as compared to the controls (P = 0.02). In patients with bacterial meningitis who developed brain infarction, CSF PAI-1 levels were higher than in those without infarction (P = 0.04).ConclusionsActivation of coagulation and attenuation of fibrinolysis in the CSF are important features of bacterial meningitis; the net effect on fibrin turnover may contribute to the development of brain infarction.