Evaluation of the Diagnostic and Prognostic Value of CSF Presepsin Levels in Patients with Postneurosurgical Ventriculitis/Meningitis

Abstract

To evaluate the diagnostic and prognostic value of CSF presepsin levels in patients with postneurosurgical ventriculitis/meningitis (PNVM). Methods: We conducted a case-control study to achieve our aims. First, we prospectively enrolled patients who had undergone neurosurgery in Beijing Tiantan Hospital from June to November 2020 and measured the CSF levels of 8 biomarkers, including presepsin and other meningitis biomarkers. The diagnostic and prognostic accuracies of presepsin levels were evaluated by determining the values for the area under the receiver operating characteristic curve (AUC). Results: Two hundred thirty-nine patients were enrolled in this study; 34 were diagnosed with confirmed ventriculitis/meningitis (cVM), 138 were classified as probable ventriculitis/ meningitis (pVM), and the others were rejected ventriculitis/meningitis (rVM). Presepsin levels effectively diagnose cVM and predict the outcomes of patients with PNVM, with thresholds of 1257.4 pg/mL and 1276.2 pg/mL and AUCs of 0.746 and 0.825, respectively. Furthermore, a joint analysis with CSF lactate (C-Lac) levels shows that the AUCs of the two markers increased to 0.856 and 0.872, respectively. Conclusion:The rapid diagnosis and prediction of the clinical outcome is important in neurosurgery. CSF presepsin levels are an impressive diagnostic and prognostic biomarker for meningitis, and when combined with C-Lac, they indeed improve the diagnostic and predictive efficiency of PNVM.

Diagnostic Accuracy of the Combination of Cerebrospinal fluid and blood Presepsin for Postoperative Meningitis after Neurosurgery: Single-Center Prospective Observational Cohort Study

“…The usefulness of isolated CSF PSP for diagnosing PNM has been reported in adults [13,14] and for diagnosing bacterial meningitis in infants [15]. Although limited data from the previous study, the normal range for CSF PSP was 50-100 pg/ml [13].…”

“…The diagnostic accuracy of PSP in detecting infection is useful for early sepsis diagnosis and subsequent mortality reduction in critically ill adult patients [11,12]. Several reports evaluated the usefulness of CSF PSP for the diagnosis of bacterial meningitis [13,14] or PNM [15]. However, there is no previous study evaluating both CSF PSP and blood PSP, and CSF/blood PSP ratio to diagnose PNM.…”

Clinical significance of cerebrospinal fluid presepsin as adjunctive biomarker for postneurosurgical meningitis: A single-center prospective observational study

“…[ 7 , 10 , 14 , 20 ] The diagnostic accuracy of PSP in detecting infection is useful for early sepsis diagnosis and subsequent mortality reduction in critically ill adult patients. [ 7 , 20 ] Several reports evaluated the usefulness of CSF PSP for the diagnosis of bacterial meningitis[ 1 , 21 ] or PNM in children. [ 16 ] However, there were no studies have evaluated both CSF PSP and blood PSP or used the CSF/blood PSP ratio to diagnose PNM.…”

Usefulness of cerebrospinal fluid presepsin (soluble CD14 subtype) as a new marker in the diagnosis of neurosurgical postoperative meningitis

“…Notably, presepsin is less susceptible to noninfectious inflammatory conditions such as trauma, burns, and surgery than other conventional sepsis markers such as procalcitonin and C-reactive protein (CRP) ( 19 , 20 ). So far, few studies have used CSF presepsin for the diagnosis of POM in the field of neurosurgery ( 14 , 21 , 22 ); thus, we aimed to investigate the utility of CSF presepsin for diagnosing meningitis after neurosurgery.…”