title: Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis.
abstract: 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.
authors.affiliation: 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
authors.forename: Francois
authors.initials: F
authors.lastname: Dubos
authors.forename: Florence
authors.initials: F
authors.lastname: Moulin
authors.forename: Vincent
authors.initials: V
authors.lastname: Gajdos
authors.forename: Nathalie
authors.initials: N
authors.lastname: De Suremain
authors.forename: Sandra
authors.initials: S
authors.lastname: Biscardi
authors.forename: Pierre
authors.initials: P
authors.lastname: Lebon
authors.forename: Josette
authors.initials: J
authors.lastname: Raymond
authors.forename: Gerard
authors.initials: G
authors.lastname: Breart
authors.forename: Dominique
authors.initials: D
authors.lastname: Gendrel
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: 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
chemical_list: 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