title: Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study.
abstract: OBJECTIVE
  To validate procalcitonin (PCT) level as the best biological marker to distinguish between bacterial and aseptic meningitis in children in the emergency department.
  
  
  METHODS
  Secondary analysis of retrospective multicenter hospital-based cohort studies.
  
  
  METHODS
  Six pediatric emergency or intensive care units of tertiary care centers in 5 European countries.
  
  
  METHODS
  Consecutive children aged 29 days to 18 years with acute meningitis.
  
  
  METHODS
  Univariate analysis and meta-analysis to compare the performance of blood parameters (PCT level, C-reactive protein level, white blood cell count, and neutrophil count) and cerebrospinal fluid parameters (protein level, glucose level, white blood cell count, and neutrophil count) quickly available in the emergency department to distinguish early on between bacterial and aseptic meningitis.
  
  
  RESULTS
  Of 198 patients analyzed, 96 had bacterial meningitis. Sensitivity of cerebrospinal fluid Gram staining was 75%. The PCT level had significantly better results than the other markers for area under the receiver operating characteristic curve (0.98; 95% confidence interval, 0.95-0.99; P = .001). At a 0.5-ng/mL threshold, PCT level had 99% sensitivity (95% confidence interval, 97%-100%) and 83% specificity (95% confidence interval, 76%-90%) for distinguishing between bacterial and aseptic meningitis. The diagnostic odds ratio between high PCT level and bacterial meningitis was 139 (95% confidence interval, 39-498), without significant heterogeneity between centers.
  
  
  CONCLUSIONS
  The PCT level is a strong predictor for distinguishing between bacterial and aseptic meningitis in children in the emergency department. Its combination with other parameters in an effective clinical decision rule could be helpful.
authors.affiliation: Department of Pediatric Emergencies and Infectious Diseases, Roger-Salengro Hospital, Centre Hopitalier Universitaire Lille and Lille-2 University, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Dubos
authors.forename: Bartosz
authors.initials: B
authors.lastname: Korczowski
authors.forename: Denizmen A
authors.initials: DA
authors.lastname: Aygun
authors.forename: Alain
authors.initials: A
authors.lastname: Martinot
authors.forename: Cristina
authors.initials: C
authors.lastname: Prat
authors.forename: Annick
authors.initials: A
authors.lastname: Galetto-Lacour
authors.forename: Juan
authors.initials: J
authors.lastname: Casado-Flores
authors.forename: Erdal
authors.initials: E
authors.lastname: Taskin
authors.forename: Francis
authors.initials: F
authors.lastname: Leclerc
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodrigo
authors.forename: Alain
authors.initials: A
authors.lastname: Gervaix
authors.forename: Sandrine
authors.initials: S
authors.lastname: Leroy
authors.forename: Dominique
authors.initials: D
authors.lastname: Gendrel
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008582:Meningitis, Aseptic / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D016920:Meningitis, Bacterial / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide