title: Predictive factors of bacterial meningitis in the patients seen in emergency departments.
abstract: OBJECTIVE
  To analyse and compare predictive factors of bacterial meningitis in the patients seen in the Emergency Departments (ED) due to an episode of acute meningitis (AM).
  
  
  METHODS
  A prospective, observational study was carried out in patients aged 15 years and older seen in ED due to AM between August 2009 and November 2015. Thirty-two variables for predicting bacterial meningitis were assessed. They covered epidemiological, comorbidity, clinical and analytical factors. Multivariate logistic regression analysis was performed.
  
  
  RESULTS
  The study included 154 patients. The diagnosis was bacterial meningitis in 53 (34.4%) patients. Four variables were significantly associated with bacterial aetiology: cerebrospinal fluid (CSF) lactate concentration ≥33mg/dl (odds ratio [OR] 50.84; 95% confidence interval [CI]: 21.63-119.47, P<.001), serum procalcitonin (PCT) ≥0.8ng/ml (OR 46.34; 95%CI: 19.71-108.89; P<.001), CSF glucose <60% of blood value (OR 20.82; 95%CI: 8.86-48.96; P=.001), CSF polymorphonuclears greater than 50% (OR 20.19; 95%CI: 8.31-49.09; P=.002]. The area under the curve for the model serum PCT≥0.8ng/ml plus CSF lactate ≥33mg/dl was 0.992 (95%CI: 0.979-1; P<.001), and achieved 99% sensitivity and 98% specificity for predicting bacterial meningitis.
  
  
  CONCLUSIONS
  Serum PCT with CSF lactate, CSF glucose and CSF polymorphonuclears evaluated in an initial assessment in the ED for patients with AM, achieved an excellent diagnostic usefulness for predicting bacterial meningitis.
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 Neurología, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Paula
authors.initials: P
authors.lastname: Lobato-Casado
authors.affiliation: Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Belén
authors.initials: B
authors.lastname: Cámara-Marín
authors.affiliation: Servicio de Neurología, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Julio Alberto
authors.initials: JA
authors.lastname: Pérez-Matos
authors.affiliation: Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: Tamara
authors.initials: T
authors.lastname: Martínez-Maroto
mesh_terms: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015415:Biomarkers
keywords: Acute meningitis; Biomarcadores; Biomarkers; Emergency department; Lactate; Lactato; Meningitis aguda; Procalcitonin; Procalcitonina; Servicio de urgencias