Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates

Reshi, Z; Nazir, Mudasir; Wani, Wasim Ahmad; Malik, Muzaffar Ahmad; Iqbal, Javeed; Wajid, Syed

doi:10.1038/jp.2017.73

Cited by 18 publications

(23 citation statements)

References 42 publications

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“…Reshi et al in their study on neonates observed higher median (interquartile range [IQR]) of CSF PCT in neonates with meningitis in comparison without nonmeningitis. 16 They hypothesized that PCT levels may get raised in blood only when meningitis is accompanied by sepsis. Source of PCT in CSF is likely from the plasma itself as blood-brain barrier gets disrupted due to infectious process.…”

Section: Discussionmentioning

confidence: 99%

“…Reshi et al reported the median and interquartile of CSF PCT as 0.47 (0.38-0.88) ng/mL in meningitis neonates and 0.26 (0.21-0.28) ng/mL in nonmeningitis neonates. 16 To detect a difference of 0.2 ng/mL between nonmeningitis and confirmed meningitis with 80% power and 5% level of significance using F-test, sample size was calculated to be 17 cases of confirmed meningitis. Considering ratio of sample as 1.5:1.5:1 (non, probable, and confirmed meningitis), we decided to enroll 25 neonates with nonmeningitis, 25 with probable and 17 with confirmed meningitis.…”

Section: Sample Sizementioning

confidence: 99%

“…15 Reshi et al also observed significant difference in CSF PCT in neonates with and without bacterial meningitis. 16 However, the roles of CSF PCT and serum to CSF PCT ratio in neonates with culture positive and culture negative meningitis are still unexplored. Thus, we planned this study with the objective of comparing serum and CSF PCT levels and ratio of serum to CSF PCT in neonates with confirmed, probable, and nonmeningitis groups.…”

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confidence: 99%

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Utility of Cerebrospinal Fluid and Serum Procalcitonin for the Diagnosis of Neonatal Meningitis

et al. 2020

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Objective Positive CSF culture is the gold standard for the diagnosis of meningitis but it carries poor sensitivity. CSF procalcitonin (PCT) is shown to have some utility for the diagnosis of meningitis though there are limited studies in neonatal age group. We planned this study to compare CSF, serum, and CSF to serum PCT levels in neonates with confirmed, probable, and nonmeningitis groups to determine its optimal cut-off in CSF and serum for diagnosing meningitis Study Design Sixty-seven neonates who qualified for lumbar puncture were enrolled in the study. Neonates were categorized into confirmed meningitis, i.e., CSF cytochemistry and culture positive (N = 17), probable meningitis, i.e., CSF cytochemistry positive but culture negative (N = 25) and nonmeningitis, i.e., both cytochemistry and culture negative (N = 25). CSF and serum samples were stored at −80°C for PCT assay. Results Significant difference was seen in mean of CSF PCT in neonates with confirmed (0.31 ng/mL), probable (0.22 ng/mL), and nonmeningitis (0.11 ng/mL) groups. Similarly, significant difference was observed in serum PCT levels also, though the ratio of serum to CSF PCT was comparable. At cut-off of 0.2 ng/mL, CSF PCT had sensitivity of 95.2% and specificity of 96% in the diagnosis of meningitis. Conclusion CSF PCT is more specific marker for the diagnosis of neonatal meningitis as compared with serum PCT and CSF to serum PCT ratio. Key Points

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Section: Discussionmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

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confidence: 99%

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Utility of Cerebrospinal Fluid and Serum Procalcitonin for the Diagnosis of Neonatal Meningitis

et al. 2020

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“…13 We previously reported that procalcitonin measurement in clean noncontaminated cerebrospinal fluid has diagnostic efficiency similar to the traditional cerebrospinal fluid parameters of total leukocyte count, protein, and sugar. 14 Moreover, routine assessment of procalcitonin in such cases may not yield additional information, but it may have clinical utility in situations where diagnosis of meningitis is in dilemma, as in case of blood contamination of cerebrospinal fluid in traumatic lumbar punctures. However, no comparisons were made with uncorrected and corrected total leukocyte counts.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Dilemma of Traumatic Lumbar Puncture: Current Standing of Cerebrospinal Fluid Leukocyte Corrections and Our Experience With Cerebrospinal Fluid Biomarkers

et al. 2018

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“…CSF cathelicidin for BM (22)) detected by original mass-spectrometry analysis). Likewise, we did not assess the diagnostic performance of LCN2 against and/or in combination newly proposed biomarkers for CNS infections such as procalcitonin and heparin-binding protein for BM (7, 9, 23–25), and CSF lipoarabinomannan for TBM (26). Additionally, we only focused our analysis on adults, leaving the utility potential of LCN2 in pediatric CNS infections unknown.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Cerebrospinal Fluid Biomarker Discovery and Validation in Patients with Central Nervous System Infections

Thanh

Casals-Pascual

Nth.

et al. 2020

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Word counts: Abstract: 245, text: 2760 2 7 Keywords: Meningitis, central nervous system infections, mass-spectrometry, lipocalin 2, 2 8 biomarkers 2 9Running title: Diagnostic biomarker discovery in central nervous system infected patients 3 0 ABSTRACT 1 Background: Central nervous system (CNS) infections are common causes of morbidity and 2 mortality worldwide. Rapid, accurate identification of the likely cause is essential for clinical 3 management and the early initiation of antimicrobial therapy, which potentially improves clinical 4 outcome. 5Methods: We applied liquid chromatography tandem mass-spectrometry on 45 cerebrospinal 6 fluid (CSF) samples from a cohort of adults with/without CNS infections to discover potential 7 diagnostic protein biomarkers. We then validated the diagnostic performance of a selected 8 biomarker candidate in an independent cohort of 364 consecutively treated adults with CNS 9 infections admitted to a referral hospital in southern Vietnam. 0Results: In the discovery cohort, we identified lipocalin 2 (LCN2) as a potential biomarker of 1 1 bacterial meningitis. The analysis of the validation cohort showed that LCN2 could discriminate 1 2 bacterial meningitis from other CNS infections, including tuberculous meningitis, cryptococcal 1 3 meningitis and viral/antibody-mediated encephalitis (sensitivity: 0.88 (95% confident interval 1 4 (CI): 0.77-0.94), specificity: 0.91 (95%CI: 0.88-0.94) and diagnostic odd ratio: 73.8 (95%CI: 1 5 31.8-171.4)). LCN2 outperformed other CSF markers (leukocytes, glucose, protein and lactate) 1 6 commonly used in routine care worldwide. The combination of LCN2 and these four routine 1 7 CSF markers resulted in the highest diagnostic performance for bacterial meningitis (area under 1 8 receiver-operating-characteristic-curve 0.96; 95%CI: 0.93-0.99).1 9Conclusions: Our results suggest that LCN2 is a sensitive and specific biomarker for 2 0 discriminating bacterial meningitis from a broad spectrum of CNS infections. A prospective 2 1 study is needed to further assess the diagnostic utility of LCN2 in the diagnosis and management 2 2 of CNS infections. 2 3 1 Central nervous system (CNS) infections cause significant mortality and morbidity worldwide, 2 but especially in low-and middle-income countries (1). Common CNS infections include 3 bacterial meningitis (BM), viral encephalitis, tuberculous meningitis (TBM) and cryptococcal 4 meningitis (2), but there are >100 documented infectious causes of CNS infections (3). 5 Additionally, over the last decade, antibody-mediated causes of encephalitis (e.g. anti-N-methyl-6 D-aspartate receptor (anti-NMDAR) encephalitis) have been recognized (4), which further 7 challenges routine diagnostics. 8 Clinical features are often insufficient to discriminate the likely cause and standard laboratory 9 investigations identify the causative agent in <60% of cases (5, 6). Critically, the clinical We thank Le 1 logistic support, and Dr Nguyen Thi Hoang Mai for her help with material collection. We are 2 indebted to patients for the...

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Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates

Cited by 18 publications

References 42 publications

Utility of Cerebrospinal Fluid and Serum Procalcitonin for the Diagnosis of Neonatal Meningitis

Utility of Cerebrospinal Fluid and Serum Procalcitonin for the Diagnosis of Neonatal Meningitis

The Diagnostic Dilemma of Traumatic Lumbar Puncture: Current Standing of Cerebrospinal Fluid Leukocyte Corrections and Our Experience With Cerebrospinal Fluid Biomarkers

Diagnostic Cerebrospinal Fluid Biomarker Discovery and Validation in Patients with Central Nervous System Infections

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