Diagnostic Value of Serum and Serum and Cerebrospinal Fluid Procalcitonin in Differentiation Bacterial from Aseptic Meningitis

Abstract

Problem statement: Acute bacterial meningitis is one of the most important causes of medical emergency diseases, which can cause high mortality and morbidity rates. Early antibiotic therapy is life saving in bacterial meningitis. One of the most common etiologies of acute meningitis is viral. Differentiation between bacterial and Aseptic meningitis is mandatory, which leads to avoid useless administration of antibiotics. Various diagnostic tests are available for diagnosis of acute bacterial meningitis; one of these tests is serum procalcitonin. Approach: This survey is a descriptive crosssectional study. During a 2 year period 50 patients over 13 years old who were admitted to Sina and Emam Reza hospitals of Tabriz University of Medical Sciences with presumptive diagnosis of acute meningitis were selected. Serum and Cerebrospinal Fluid (CSF) procalcitonin of the patients were measured by semiquantative chromatographic PCT-Q Assay. Statistical data's of the patients were analyzed by SPSS 15. Results: 38% of the patients had acute bacterial and 62% aseptic meningitis, on the basis of positive clinical and lab tests. 0.5ng mL −1 of serum pricalcitonin was cut off point, which correlated to sensitivity of 100%, positive predictive value of 82.6%, specificity of 87.09% and negative predictive value of 100%. CSF procalcitonin cut off of 0.5ng mL −1 had sensitivity of 100% specificity of 84.21%, positive predictive value of 88.88% and negative predictive value of 90.62%. Conclusion: Serum procalcitonin cut off of 0.5 ng mL −1 has sensitivity and negative predictive value of 100%. This test can be a valuable measure in screening and differentiation of bacterial from aseptic meningitis.

Procalcitonin as a Marker for Early Diagnosis of Sepsis

“…However, in present study there was not a significant correlation between procalcitonin serum level sat zero and 72 h times with gender; which these results are in agreement with other studies (Heper et al, 2006;PCCM, 2013;Makoo et al, 2010;Ahmadinejad et al, 2009). Although, in present study, in a group of patients who have a negative blood cultures, negative peripheral blood smears and negative inflammatory marker, there was a significant correlation between procalcitonin amount of 72 h and gender and it was 75% for female and 25% for male gender, but it should be noted that there were 8 patients in this group and most of them, 6 patients, were female.…”

“…Few studies have been done on the distinguish value of procalcitonin serum levels and their results have been controversial (PCCM, 2013;Makoo et al, 2010;Heper et al, 2006).…”

The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis

“…Three studies [24,26,40] have assessed the diagnostic accuracy of PCT in CSF using the same cut-off value of 0.5 ng/mL. The reported sensitivities ranged from 0.55 to 1.0, and the reported specificities in the studies ranged from 0.93 to 1.0.…”

“…The cut-off range for PCT varied amongst the studies and ranged between 0.25 ng/mL to 2.13 ng/mL. Procalcitonin assay methods also A c c e p t e d M a n u s c r i p t 7 varied between studies and included the LUMItest (BRAHMS Diagnostika, Berlin, Germany) [24,30], Kryptor test (BRAHMS, Saint-Quen, France) [25,29,31], VIDAS BRAHMS PCT assay [26][27], RayBio Human Procalcitonin ELISA kit [23], and ELECSYS BRAHMS PCT test [28].…”

“…Several studies have attempted to study the diagnostic accuracy of PCT in differentiating between bacterial and viral meningitis in adult patients [23][24][25][26][27][28][29][30][31]. The reported results of these studies are varied and a consensus has yet to be reached on the diagnostic value of PCT in meningitis.…”