title: Procalcitonin as a Serum Biomarker for Differentiation of Bacterial Meningitis From Viral Meningitis in Children: Evidence From a Meta-Analysis.
abstract: Several studies have explored the use of serum procalcitonin (PCT) in differentiating between bacterial and viral etiologies in children with suspected meningitis. We pooled these studies into a meta-analysis to determine the PCT diagnostic accuracy. All major databases were searched through March 2015. No date or language restrictions were applied. Eight studies (n = 616 pediatric patients) were included. Serum PCT assay was found to be very accurate for differentiating the etiology of pediatric meningitis with pooled sensitivity and specificity of 0.96 (95% CI = 0.92-0.98) and 0.89 (95% CI = 0.86-0.92), respectively. The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and area under the curve (AUC) for PCT were 7.5 (95% CI = 5.6-10.1), 0.08(95% CI = 0.04-0.14), 142.3 (95% CI = 59.5-340.4), and 0.97 (SE = 0.01), respectively. In 6 studies, PCT was found to be superior than CRP, whose DOR was only 16.7 (95%CI = 8.8-31.7). Our meta-analysis demonstrates that serum PCT assay is a highly accurate and powerful test for rapidly differentiating between bacterial and viral meningitis in children.
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland bmhenry55@gmail.com.
authors.forename: Brandon Michael
authors.initials: BM
authors.lastname: Henry
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Joyeeta
authors.initials: J
authors.lastname: Roy
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Piravin Kumar
authors.initials: PK
authors.lastname: Ramakrishnan
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Jens
authors.initials: J
authors.lastname: Vikse
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Krzysztof A
authors.initials: KA
authors.lastname: Tomaszewski
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Jerzy A
authors.initials: JA
authors.lastname: Walocha
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D016920:Meningitis, Bacterial / Q000097:blood* / Q000175:diagnosis*; D008587:Meningitis, Viral / Q000097:blood* / Q000175:diagnosis*; D016017:Odds Ratio; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D002116:Calcitonin
keywords: C-reactive protein (CRP); bacterial meningitis; children; diagnosis; meta-analysis; viral meningitis