Blood Procalcitonin Level as a Diagnostic Marker of Pediatric Bacterial Meningitis: A Systematic Review and Meta-Analysis

Abstract

Early diagnosis and treatment of bacterial meningitis in children are essential, due to the high mortality and morbidity rates. However, lumbar puncture is often difficult, and cerebrospinal fluid (CSF) culture takes time. This meta-analysis aims to determine the diagnostic accuracy of blood procalcitonin for detecting bacterial meningitis in children. We conducted a systematic search on electronic databases to identify relevant studies. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, and a hierarchical summary receiver operating characteristic curve and area under the curve (AUC) were determined. Eighteen studies with 1462 children were included in the analysis. The pooled sensitivity, specificity, and the DOR of blood procalcitonin for detecting bacterial meningitis were 0.87 (95% confidence interval (CI): 0.78–0.93); 0.85 (95% CI: 0.75–0.91), and 35.85 (95% CI: 10.68–120.28), respectively. The AUC for blood procalcitonin was 0.921. Blood procalcitonin also showed higher diagnostic accuracy for detecting bacterial meningitis than other conventional biomarkers, including serum C-reactive protein and leukocyte count, CSF leukocyte and neutrophil count, and CSF protein and glucose levels. Blood procalcitonin can be a good supplemental biomarker with high diagnostic accuracy in detecting bacterial meningitis in children.

Diagnostic accuracy of inflammatory markers in adults with suspected central nervous system infections

“…Previous studies showed that blood levels of acute phase reactants CRP and procalcitonin were helpful in differentiation of CNS infection and specifically bacterial meningitis from other disorders. 22 , 31 , 32 However, these studies were not performed in the whole population of patients with suspected CNS infection and did not include patients with systemic infections without CNS involvement, where acute phase reactants are also elevated. Our results indicate that inflammatory markers in blood have a limited diagnostic value in the diagnosis of CNS infection and these cannot be used to exclude this.…”

Overview of Pediatric Procalcitonin Testing Patterns in a Tertiary Care Children’s Hospital

“…For instance, in the differentiation of bacterial from viral meningitis, PCT has shown promise in multiple studies with sensitivities ranging from 70% to 100% and specificity ranging from 81% to 100%. [7][8][9][10][34][35][36][37] In many of these studies, PCT performed better than CRP, which had a sensitivity ranging from 70% to 86% and specificity ranging from 75% to 90%. 7,34,35 In addition, PCT has demonstrated a more consistent downtrend from the time of admission to 72 hours after starting antibiotics, while CRP did not show this pattern of change, suggesting that PCT may be superior in predicting response to therapy.…”

Epidemiology, Drug Resistance, and Risk Factors for Mortality Among Hematopoietic Stem Cell Transplantation Recipients with Hospital-Acquired Klebsiella pneumoniae Infections: A Single-Center Retrospective Study from China

“… 45 When the body is infected, PCT can be rapidly produced and released into blood under the action of inflammatory factors or bacterial toxins. 46 PCT is strongly associated with APACHE II and SOFA, two important scoring systems for assessing the severity of a patient’s condition. That is, the more severe the disease, the higher the APACHE II and sofa scores, the greater the PCT value, and vice versa.…”