title: [Diagnostic usefulness of procalcitonin and C-reactive protein in the Emergency Department for predicting bacterial meningitis in the elderly].
abstract: OBJECTIVE
  To analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis (BM) in the elderly (>74 years of age).
  
  
  METHODS
  A prospective, observational, descriptive, analytical study of 220 consecutive patients aged ≥1year and diagnosed with acute meningitis in an emergency department between September 2009 and July 2014.
  
  
  RESULTS
  A total of 220 patients (136 [62%] male) were studied. The mean age was 30±26years, with BM being diagnosed in 17/83 patients from 1 to 14years of age, 32/111 from 15 to 74years of age, and 17/26 patients ≥75years of age. PCT had the highest area under the receiver operating characteristic curve (AUC) (0.972; 95%CI, 0.946-0,998; P<.001) to predict bacterial meningitis. With a cut-off of ≥0.52ng/mL, PCT achieved 93% sensitivity and 86% specificity, and for patients over 75years of age 96% sensitivity and 75% specificity, with the same AUC (0.972). The AUC for CRP was 0.888, and a ≥54,4mg/L cut-off achieved 91% sensitivity and 78% specificity, and for patients over 75years of age an AUC of only 0.514 achieved with 97% sensitivity and 43% specificity.
  
  
  CONCLUSIONS
  For all patients with acute meningitis in the emergency department, PCT has a high diagnostic power, outperforming CRP and Leukocytes for detection of bacterial etiology, but CPR is of not useful in the elderly.
authors.affiliation: Servicio de Neurología, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Morales-Casado
authors.affiliation: Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España. Electronic address: agustinj@sescam.jccm.es.
authors.forename: Agustín
authors.initials: A
authors.lastname: Julián-Jiménez
authors.affiliation: Servicio de Geriatría, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Moreno-Alonso
authors.affiliation: Servicio de Geriatría, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Eder
authors.initials: E
authors.lastname: Valente-Rodríguez
authors.affiliation: Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Diego
authors.initials: D
authors.lastname: López-Muñoz
authors.affiliation: Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: José
authors.initials: J
authors.lastname: Saura-Montalbán
authors.affiliation: Farmacología Clínica, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cuena-Boy
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Anciano; Biomarcadores; Biomarkers; C-Reactive protein; Elderly; Emergency department; Meningitis; Procalcitonin; Procalcitonina; Proteína C reactiva; Servicio de urgencias