Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis.
OBJECTIVE
To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED).


METHODS
All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined. Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison.


RESULTS
Among the 167 patients included, 21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86% and 60% sensitivity rates, respectively. PCT (>/=0.5 ng/mL) and CSF protein (>/=0.5 g/L) were the best biologic tests, with 89% and 86% sensitivity rates, 89% and 78% specificity rates, adjusted odds ratios of 108 (95% CI, 15-772) and 34 (95% CI, 5-217), and areas under the ROC curves of 0.95 and 0.93, respectively.


CONCLUSIONS
PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.
Dubos
Francois
F
Clinical Epidemiology Unit, Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Paris Descartes University, and INSERM U149, Paris, France. martin.chalumeau@wanadoo.fr
Moulin
Florence
F
Gajdos
Vincent
V
De Suremain
Nathalie
N
Biscardi
Sandra
S
Lebon
Pierre
P
Raymond
Josette
J
Breart
Gerard
G
Gendrel
Dominique
D
Chalumeau
Martin
M
D000293:Adolescent; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D008582:Meningitis, Aseptic / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D009504:Neutrophils / Q000378:metabolism; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D015415:Biomarkers; C000606589:CALCA protein, human; D002556:Cerebrospinal Fluid Proteins; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D005947:Glucose; D015740:Calcitonin Gene-Related Peptide