Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study.
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.
Dubos
François
F
Department of Pediatric Emergencies and Infectious Diseases, Roger-Salengro Hospital, Centre Hopitalier Universitaire Lille and Lille-2 University, Lille, France.
Korczowski
Bartosz
B
Aygun
Denizmen A
DA
Martinot
Alain
A
Prat
Cristina
C
Galetto-Lacour
Annick
A
Casado-Flores
Juan
J
Taskin
Erdal
E
Leclerc
Francis
F
Rodrigo
Carlos
C
Gervaix
Alain
A
Leroy
Sandrine
S
Gendrel
Dominique
D
Bréart
Gérard
G
Chalumeau
Martin
M
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
D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide