患有脑脊液（CSF）多细胞症状的不同诱因患者的脑脊液特征存在重叠。在这里，我们对一家大型医院治疗的CSF多细胞症状患者进行了特征描述。本研究回顾性研究了德国一所大学医院2015年1月至2017年12月期间接受治疗并有CSF白细胞计数>5个/µl的1150名患者。收集了有关临床表现、实验室参数、诊断和预后的信息。对临床和实验室特征进行了测试，以区别细菌性脑膜炎（BM）和其他导致CSF多细胞症状的原因。CSF多细胞症状最常见的病因是中枢神经系统感染（34%：20%有已检测到的致病菌，14%没有）、自身免疫疾病（21%）和肿瘤性疾病（16%）。与自身免疫疾病（11个/µl，p=0.001）、肿瘤性疾病（19个/µl，p=0.01）和其他原因（11个/µl，p<0.001）相比，带有已检测到的致病菌的中枢神经系统感染的CSF细胞计数较高（中位数为82个/µl）。使用CHANCE评分来区分BM和其他CSF多细胞症状的原因：多元回归分析发现CSF细胞计数>100个/µl、CSF蛋白>100 mg/dl、CRP>5 mg/dl、白细胞计数增高、精神异常和颈部僵硬是重要指标。CHANCE评分识别BM患者的敏感性（92.1%）和特异性（90.9%）较高（推导队列：AUC：0.955，验证队列：AUC：0.956）。总体而言，CSF多细胞症状的最常见原因包括感染性、肿瘤性或自身免疫性中枢神经系统疾病，约占患者的70%。CHANCE评分有助于识别BM高风险患者并支持临床决策。© 2023. 作者。

There is an overlap in the cerebrospinal fluid (CSF) characteristics of patients presenting with different etiologies of CSF pleocytosis. Here, we characterized patients with CSF pleocytosis treated in a large hospital.A retrospective cohort study of 1150 patients with an elevated CSF leukocyte count > 5 cells/µl treated at a university hospital in Germany from January 2015 to December 2017 was performed. Information on clinical presentation, laboratory parameters, diagnosis and outcome was collected. Clinical and laboratory features were tested for their potential to differentiate between bacterial meningitis (BM) and other causes of CSF pleocytosis.The most common etiologies of CSF pleocytosis were CNS infections (34%: 20% with detected pathogen, 14% without), autoimmune (21%) and neoplastic diseases (16%). CSF cell count was higher in CNS infections with detected pathogen (median 82 cells/µl) compared to autoimmune (11 cells/µl, p = 0.001), neoplastic diseases (19 cells/µl, p = 0.01) and other causes (11 cells/µl, p < 0.001). The CHANCE score was developed to differentiate BM from other causes of CSF pleocytosis: Multivariate regression revealed that CSF cell count > 100 cells/µl, CSF protein > 100 mg/dl, CRP > 5 mg/dl, elevated white blood cell count, abnormal mental status and nuchal rigidity are important indicators. The CHANCE score identified patients with BM with high sensitivity (92.1%) and specificity (90.9%) (derivation cohort: AUC: 0.955, validation cohort: AUC: 0.956).Overall, the most common causes for CSF pleocytosis include infectious, neoplastic or autoimmune CNS diseases in ~ 70% of patients. The CHANCE score could be of help to identify patients with high likelihood of BM and support clinical decision making.© 2023. The Author(s).