The diagnostic value of cerebrospinal fluids procalcitonin and lactate for the differential diagnosis of post-neurosurgical bacterial meningitis and aseptic meningitis

Li, Youran; Zhang, Guojun; Ma, Ruimin; Du, Yamei; Zhang, Limin; Li, Fangqiang; Fang, Fang; Lv, Hong; Wang, Qian; Zhang, Yan; Kang, Xiaojian

doi:10.1016/j.clinbiochem.2014.10.007

Cited by 61 publications

(53 citation statements)

References 29 publications

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“…Compared to WBC count and serum CRP, serum PCT is a good diagnostic marker for intracranial bacterial infection. Li et al (30) reported that combined with CSF PCT and CSF lactic acid, serum PCT could effectively identify bacterial meningitis and non-bacterial meningitis after craniotomy. In our study, ROC curve analysis showed that the diagnostic accuracy of CSF PCT is the highest among the parameters studied and it can be used as an optimal index for early diagnosis of intracranial infection after craniotomy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy

2017

Braz J Med Biol Res

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Intracranial infection is a common clinical complication after craniotomy. We aimed to explore the diagnostic and prognostic value of dynamic changing procalcitonin (PCT) in early intracranial infection after craniotomy. A prospective study was performed on 93 patients suspected of intracranial infection after craniotomy. Routine peripheral venous blood was collected on the day of admission, and C reactive protein (CRP) and PCT levels were measured. Cerebrospinal fluid (CSF) was collected for routine biochemical, PCT and culture assessment. Serum and CSF analysis continued on days 1, 2, 3, 5, 7, 9, and 11. The patients were divided into intracranial infection group and non-intracranial infection group; intracranial infection group was further divided into infection controlled group and infection uncontrolled group. Thirty-five patients were confirmed with intracranial infection after craniotomy according to the diagnostic criteria. The serum and cerebrospinal fluid PCT levels in the infected group were significantly higher than the non-infected group on day 1 (P<0.05, P<0.01). The area under curve of receiver operating characteristics was 0.803 for CSF PCT in diagnosing intracranial infection. The diagnostic sensitivity and specificity of CSF PCT was superior to other indicators. The serum and CSF PCT levels have potential value in the early diagnosis of intracranial infection after craniotomy. Since CSF PCT levels have higher sensitivity and specificity, dynamic changes in this parameter could be used for early detection of intracranial infection after craniotomy, combined with other biochemical indicators.

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Section: Discussionmentioning

confidence: 99%

Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy

2017

Braz J Med Biol Res

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“…In people, brain hypoxia and vascular compromise (ie, intracranial hemorrhage, mass lesions, trauma, stroke, seizures, hypoglycemic coma) also increase CSF [LAC] . When confounding conditions have been excluded, CSF [LAC] can differentiate septic from aseptic meningitis . In a meta‐analysis including 33 studies and 1,885 people, the measurement of CSF [LAC] had a pooled sensitivity of 93% (95% CI 0.89–0.96) and specificity of 96% (95% CI 0.93–0.98) in discriminating septic from aseptic meningitis using a cut‐off of 3.9 mmol/L .…”

Section: Measurement Of Lactate In Other Body Fluidsmentioning

confidence: 99%

“…122,123 When confounding conditions have been excluded, CSF [LAC] can differentiate septic from aseptic meningitis. 119,120,124,125 In a meta-analysis including 33 studies and 1,885 people, the measurement of CSF [LAC] had a pooled sensitivity of 93% (95% CI 0.89-0.96) and specificity of 96% (95% CI 0.93-0.98) in discriminating septic from aseptic meningitis using a cut-off of 3.9 mmol/L. 126 Similarly, in a meta-analysis that included 25 studies and 1,692 people but excluded those with CNS disease that could increase CSF [LAC] (eg, stroke, seizures, cerebral hypoxia, brain trauma), CSF [LAC] had a pooled sensitivity of 96% (95% CI, 0.95-0.98), specificity of 94% (95% CI, 0.93-0.96), and AUROC of 0.984 in differentiating septic meningitis from aseptic meningitis.…”

Section: Cerebrospinal Fluidmentioning

confidence: 99%

Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia

Rosenstein

Tennent‐Brown

Hughes

2018

J Vet Emergen Crit Care

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“…These results suggest that early high serum procalcitonin concentration is a reliable indicator of bacterial CNS infection in patients with external ventricular drains. Another study found the combination of both CSF procalcitonin and CSF lactate concentrations, using cutoff values of 0.075 ng/mL and 3.45 mmol/L, respectively, to have a high diagnostic accuracy (sensitivity of 96% and negative predictive value of 97.6%) in distinguishing between post-neurosurgical bacterial and aseptic meningitis [85]. While these studies are quite supportive, both are small and require further validation.…”

Section: Procalcitoninmentioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

698

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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The diagnostic value of cerebrospinal fluids procalcitonin and lactate for the differential diagnosis of post-neurosurgical bacterial meningitis and aseptic meningitis

Cited by 61 publications

References 29 publications

Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy

Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy

Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

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