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Here, we characterized patients with CSF pleocytosis treated in a large hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study of 1150 patients with an elevated CSF leukocyte count\u2009&gt;\u20095 cells\/\u00b5l 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\/\u00b5l) compared to autoimmune (11 cells\/\u00b5l,<jats:italic>p<\/jats:italic>\u2009=\u20090.001), neoplastic diseases (19 cells\/\u00b5l,<jats:italic>p<\/jats:italic>\u2009=\u20090.01) and other causes (11 cells\/\u00b5l,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The CHANCE score was developed to differentiate BM from other causes of CSF pleocytosis: Multivariate regression revealed that CSF cell count\u2009&gt;\u2009100 cells\/\u00b5l, CSF protein\u2009&gt;\u2009100\u00a0mg\/dl, CRP\u2009&gt;\u20095\u00a0mg\/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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Overall, the most common causes for CSF pleocytosis include infectious, neoplastic or autoimmune CNS diseases in\u2009~\u200970% of patients. The CHANCE score could be of help to identify patients with high likelihood of BM and support clinical decision making.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s15010-023-02087-8","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T07:02:34Z","timestamp":1693551754000},"page":"219-229","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Characterization and diagnosis spectrum of patients with cerebrospinal fluid pleocytosis"],"prefix":"10.1007","volume":"52","author":[{"given":"Susanne","family":"Dyckhoff-Shen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan P.","family":"Bewersdorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina C.","family":"Teske","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"V\u00f6lk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Walter","family":"Pfister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Koedel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Klein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"2087_CR1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s42466-020-0051-z","volume":"2","author":"H Tumani","year":"2020","unstructured":"Tumani H, Petereit HF, Gerritzen A, Gross CC, Huss A, Isenmann S, Jesse S, Khalil M, Lewczuk P, Lewerenz J, et al. 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