title: Diagnostic Value of CRP, Procalcitonin, and Ferritin Levels in Cerebrospinal Fluid of Children with Meningitis.
abstract: OBJECTIVE
  Bacterial meningitis is a serious disease with high rate of mortality and morbidity in children. Invasion of pathogens causes brain and meningeal inflammation, which leads to the release of biomarkers into cerebrospinal fluid (CSF). Identification of these biomarkers can help the physicians to differentiate between bacterial and aseptic meningitis. In the current study, some of these biomarkers such as Procalcitonin, C reactive protein (CRP), and Ferritin, were compared in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis.
  
  
  METHODS
  In a prospective cross sectional study in a referral children hospital in Tehran during 2011- 2013, the CSF levels of Procalcitonin, Ferritin, and CRP were measured in 57 children with clinically suspected meningitis. The Mann-Whitney u test and the chi-square test were used to compare two groups, children with bacterial and aseptic meningitis. The cut-offs of biomarker levels for differentiation between the 2 groups were constructed by receiver-operating - characteristic curve (ROC).
  
  
  RESULTS
  57 subjects (30 bacterial and 27 aseptic meningitis), were enrolled in this survey. In comparing the two groups, the CSF levels of Ferritin, CRP, and procalcitonin in bacterial meningitis were significantly higher than in aseptic meningitis (P values=˂0.001, 0.001, ˂0.001respectively), with sensitivity/ specificity being 92.9% / 68%, 92.9% / 84%, and 96.4% / 80%, respectively. Positive Predictive Values (PPV) were, correspondingly, 96.4%, 92.8%, and 92.8% for procalcitonin, Ferritin, and CRP. Corresponding Negative Predictive Values (NPV) were, respectively equal to 95.4%, 70%, and 88%.
  
  
  CONCLUSIONS
  CSF of children with bacterial meningitis contains higher levels of inflammatory mediators including Procalcitonin, Ferritin, and CRP, compared to aseptic meningitis The biomarkers provided high sensitivity (especially PCT) and specificity (especially CRP). Using these complementary biomarkers would be useful for early diagnosis of bacterial meningitis and selection of appropriate treatment.
authors.affiliation: Research Center of Pediatric Infectious Diseases, Qom University of Medical Sciences and Health services, Qom, Iran.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Shokrollahi
authors.affiliation: Research Center of Pediatric Infectious Diseases, Iran University of Medical science, Tehran, Iran.
authors.forename: Khalil
authors.initials: K
authors.lastname: Shabanzadeh
authors.affiliation: Research Center of Pediatric Infectious Diseases, Iran University of Medical science, Tehran, Iran.
authors.forename: Samileh
authors.initials: S
authors.lastname: Noorbakhsh
authors.affiliation: Research Center of Pediatric Infectious Diseases, Iran University of Medical science, Tehran, Iran.
authors.forename: Azardokht
authors.initials: A
authors.lastname: Tabatabaei
authors.affiliation: Research Center of Pediatric Infectious Diseases, Qom University of Medical Sciences and Health services, Qom, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Movahedi
authors.affiliation: Dental Research Center, Dentistry Research Institute, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Shamshiri
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000134:cerebrospinal fluid; D002097:C-Reactive Protein / Q000134:cerebrospinal fluid*; D002116:Calcitonin / Q000134:cerebrospinal fluid*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000134:cerebrospinal fluid*; D006801:Humans; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008297:Male; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000453:epidemiology; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D002116:Calcitonin; D002097:C-Reactive Protein; D005293:Ferritins
keywords: CRP; CSF; ferritin; meningitis; pathogens; procalcitonin