Diagnostic Utility of Cerebrospinal Fluid Procalcitonin in Neonatal Meningitis

Abstract

We aimed to study the diagnostic utility of cerebrospinal fluid (CSF) procalcitonin (PCT) in neonates with meningitis. All the neonates with sepsis who qualified for lumbar puncture were prospectively evaluated. The neonates were classified into Meningitis and No meningitis group based on predefined criteria. CSF PCT was estimated in these neonates along with cytological and biochemical parameters. A total of 113 neonates were included in the study with 29 in the meningitis group and 84 in the no meningitis group. The median PCT levels were higher in babies with meningitis as compared to those without meningitis [0.194 (0.034–0.534) in meningitis group vs. 0.012 (0.012–0.012) ng/ml in no meningitis group, p < 0.001]. The area under curve for CSF PCT was 0.867 (0.77–0.95) and at a cut-off level of 0.120 ng/ml CSF PCT had a sensitivity of 83%, specificity of 84% and positive and negative predictive likelihood ratios of 5.35 and 0.20, respectively for the diagnosis of meningitis. CSF PCT has a good diagnostic accuracy similar to other parameters in the diagnosis of neonatal meningitis and can be considered as an additional diagnostic marker particularly when CSF culture is negative and cytochemical analysis is inconclusive.

Role of neonatal cerebrospinal fluid cytology in correlation to C-reactive protein, blood culture, risk factors and clinical outcomes in neonatal intensive care

“…[ 22 ] It can serve as an add-on to the diagnostic marker. [ 23 ] Studies have even found them to be more useful than serum-based assays. [ 24 ] However, this pose acts as an expensive affair.…”

Meta-analysis of Cerebrospinal Fluid Cell Count and Biochemistry to Diagnose Meningitis in Infants Aged < 90 Days

“…Recently, normative ranges were derived from studies on nearly asymptomatic neonates, but these values cannot be used as thresholds for diagnosing bacterial meningitis in symptomatic neonates 18 . Newer CSF biomarkers have been evaluated in a limited number of studies, but these are not yet ready for introduction in clinical practice [19][20][21][22][23][24] .…”

“…18 Newer CSF biomarkers have been evaluated in a limited number of studies, but these are not yet ready for introduction in clinical practice. [19][20][21][22][23][24] Although many studies on the role of CSF cytochemistry in neonates and young infants have been published, the thresholds used varied widely across the studies. As a result, the reported sensitivities and specificities also varied.…”

“…18 Newer CSF biomarkers have been evaluated in a limited number of studies, but these are not yet ready for introduction in clinical practice. 19 20 21 22 23 24…”