Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study. Issue 11 (16th August 2016)

• Record Type: Journal Article
• Authors: Alons, Imanda M. E.; Verheul, Rolf J.; Kuipers, Irma; Jellema, Korné; Wermer, Marieke J. H.; Algra, Ale; Ponjee, Gabriëlle
• Is Part Of: Brain and behavior. Volume 6:Issue 11(2016)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2016-08-16
• Subjects: bacterial meningitis -- cerebrospinal fluid -- diagnostic marker -- external ventricular drain -- meningitis -- neurosurgical intervention -- procalcitonin; Neurology -- Periodicals; Neurosciences -- Periodicals; Psychology -- Periodicals; Psychiatry -- Periodicals; 616.8005
• DOI: 10.1002/brb3.545
• Languages: English
• ISSNs: 2162-3279

Abstract

Abstract: Objectives: Bacterial meningitis is a severe but treatable condition. Clinical symptoms may be ambiguous and current diagnostics lack sensitivity and specificity, complicating diagnosis. Procalcitonin (PCT) is a protein that is elevated in serum in bacterial infection. We aimed to assess the value of PCT in cerebrospinal fluid (CSF) in the diagnosis of bacterial meningitis. Methods: We included patients with bacterial meningitis, both community acquired and post neurosurgery. We included two comparison groups: patients with viral meningitis and patients who underwent lumbar punctures for noninfectious indications. We calculated mean differences and 95% confidence intervals of procalcitonin in CSF and plasma in patients with and without bacterial meningitis. Results: Average PCT concentrations in CSF were 0.60 ng mL −1 (95% CI: 0.29–0.92) in the bacterial meningitis group ( n = 26), 0.81 (95% CI: 0.33–1.28) in community‐acquired meningitis ( n = 16) and 0.28 (95% CI: 0.10–0.45) in postneurosurgical meningitis ( n = 10), 0.10 ng mL −1 (95% CI: 0.08–0.12) in the viral meningitis group ( n = 14) and 0.08 ng mL −1 (95% CI: 0.06–0.09) in the noninfectious group ( n = 14). Mean difference of PCT‐CSF between patients with community‐acquired bacterial meningitis and with viral meningitis was 0.71 ng mL −1 (95% CI: 0.17–1.25) and 0.73 ng mL −1 (95% CI: 0.19–1.27) for community‐acquired bacterial meningitis versus the noninfectious group. The median PCT CSF: plasma ratio was 5.18 in postneurosurgical and 0.18 in community‐acquired meningitis (IQR 4.69 vs. 0.28). Conclusion: Procalcitonin in CSF was significantly higher in patients with bacterial meningitis when compared with patients with viral or no meningitis. PCT in CSF may be a valuable marker in diagnosing bacterial meningitis, and could become especially useful in patients after neurosurgery. Abstract : We determined procalcitonin in CSF in patients suspected of bacterial meningitis. We found procalcitonin is raised in CSF in bacterial meningitis and may become a diagnostic marker in these patients.