Youran Li1, Guojun Zhang2, Ruimin Ma1, Yamei Du1, Limin Zhang1, Fangqiang Li1, Fang Fang1, Hong Lv1, Qian Wang1, Yan Zhang1, Xixiong Kang3. 1. Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. 2. Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: tiantanzgj@163.com. 3. Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Abstract
OBJECTIVES: Distinguishing between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. This study aims to evaluate the combined diagnostic value of CSF procalcitonin and lactate as novel PNBM markers in hospitalized post-neurosurgery patients. DESIGN AND METHODS: This study was performed using CSF samples, collected by lumbar puncture, from 178 PNBM-suspected patients enrolled in a retrospective clinical study. The levels of CSF procalcitonin and lactate were appropriately assayed and the combined diagnostic value of these markers was assessed using receiver operating characteristic (ROC) curves, a two by two table, and non-parametric tests. RESULTS: Fifty of the 178 patients were diagnosed with PNBM, based on the clinical symptoms and laboratory results. These PNBM patients showed significantly elevated levels of CSF procalcitonin and CSF lactate compared with the non-PNBM group (p<0.001 for both). It was revealed that the cut-off values for the diagnosis of PNBM were: 0.075ng/mL (sensitivity, 68%; specificity, 73%) for procalcitonin and 3.45mmol/L (sensitivity, 90%; specificity, 85%) for lactate. A serial test combining the levels of these two markers showed decreased sensitivity (64%) and increased specificity (91%), compared with either marker alone. In contrast, a parallel test combining the levels of these both markers showed increased sensitivity (96%) and decreased specificity (65%), compared with either marker alone. CONCLUSION: Our study shows that the combined use of CSF procalcitonin and lactate can reliably distinguish between PNBM and non-PNBM and can be included in the design of diagnostic approaches to circumvent the shortcomings of conventional methods.
OBJECTIVES: Distinguishing between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. This study aims to evaluate the combined diagnostic value of CSF procalcitonin and lactate as novel PNBM markers in hospitalized post-neurosurgery patients. DESIGN AND METHODS: This study was performed using CSF samples, collected by lumbar puncture, from 178 PNBM-suspected patients enrolled in a retrospective clinical study. The levels of CSF procalcitonin and lactate were appropriately assayed and the combined diagnostic value of these markers was assessed using receiver operating characteristic (ROC) curves, a two by two table, and non-parametric tests. RESULTS: Fifty of the 178 patients were diagnosed with PNBM, based on the clinical symptoms and laboratory results. These PNBMpatients showed significantly elevated levels of CSF procalcitonin and CSFlactate compared with the non-PNBM group (p<0.001 for both). It was revealed that the cut-off values for the diagnosis of PNBM were: 0.075ng/mL (sensitivity, 68%; specificity, 73%) for procalcitonin and 3.45mmol/L (sensitivity, 90%; specificity, 85%) for lactate. A serial test combining the levels of these two markers showed decreased sensitivity (64%) and increased specificity (91%), compared with either marker alone. In contrast, a parallel test combining the levels of these both markers showed increased sensitivity (96%) and decreased specificity (65%), compared with either marker alone. CONCLUSION: Our study shows that the combined use of CSF procalcitonin and lactate can reliably distinguish between PNBM and non-PNBM and can be included in the design of diagnostic approaches to circumvent the shortcomings of conventional methods.
Authors: Juliana M Curti; Gustavo R Queiroz; Priscilla F V Pereira; Mayara C Anjos; Karina K M C Flaiban; Júlio A N Lisbôa Journal: Can J Vet Res Date: 2020-04 Impact factor: 1.310
Authors: Allan R Tunkel; Rodrigo Hasbun; Adarsh Bhimraj; Karin Byers; Sheldon L Kaplan; W Michael Scheld; Diederik van de Beek; Thomas P Bleck; Hugh J L Garton; Joseph R Zunt Journal: Clin Infect Dis Date: 2017-03-15 Impact factor: 9.079