This prospective cross-sectional study evaluated the diagnostic and prognostic role of cerebrospinal fluid (CSF) tumor necrosis factor-alpha (TNF-α) in children with cerebral malaria (CM) and its role in the differentiation of CM from non-cerebral severe malaria. CSF TNF-α was measured using a human TNF-α enzyme-linked immunosorbent assay kit of 39 cases of CM and 19 cases of non-cerebral severe malaria. CSF TNF-α levels were significantly higher in CM (p < 0.001). Based on the receiver operating characteristics curve, a cutoff value of CSF TNF-α was 5.7 pg/ml for diagnosis of CM with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 87.2%, 94.7%, 97.1% and 78.3% respectively. The cutoff value of CSF TNF-α was 13.7 pg/ml for predicting adverse outcomes in CM with sensitivity, specificity, PPV and NPV of 100%, 96.8%, 88.9% and 100%, respectively. However, the cutoff value of CSF TNF-α was 4.96 pg/ml for predicting adverse outcomes in non-cerebral severe malaria with a sensitivity, specificity, PPV and NPV of 100%, 94.1%, 88.9% and 100% respectively. So, CSF TNF-α is an excellent biomarker and can be used as a diagnostic and prognostic tool. More studies are needed to establish CSF TNF-α as a predictor of neurological sequelae.

中文翻译：

---

脑型疟疾儿童脑脊液肿瘤坏死因子-α（TNF-α）水平。

这项前瞻性横断面研究评估了脑脊液 (CSF) 肿瘤坏死因子-α (TNF-α) 在脑型疟疾 (CM) 儿童中的诊断和预后作用及其在区分 CM 和非脑型严重疟疾中的作用。采用人TNF-α酶联免疫吸附测定试剂盒对39例CM和19例非脑型重症疟疾进行脑脊液TNF-α检测。CM 中 CSF TNF-α 水平显着较高 (p < 0.001)。根据受试者工作特征曲线，CSF TNF-α诊断 CM 的临界值为 5.7 pg/ml，敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 分别为 87.2%、94.7%，分别为97.1%和78.3%。CSF TNF-α 预测 CM 不良结局的临界值为 13.7 pg/ml，敏感性、特异性、PPV 和 NPV 分别为 100%、96.8%、88.9% 和 100%。然而，CSF TNF-α 预测非脑部严重疟疾不良后果的临界值为 4.96 pg/ml，敏感性、特异性、PPV 和 NPV 分别为 100%、94.1%、88.9% 和 100%。因此，CSF TNF-α是一种优秀的生物标志物，可用作诊断和预后工具。需要更多的研究来确定脑脊液 TNF-α 作为神经系统后遗症的预测因子。