Ability of procalcitonin to predict bacterial meningitis in the emergency department
Introduction: The aim of this study was to analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis and predicting bacteraemia. Methods: Prospective, observational, and descriptive analytical study of 98 consecutive patients aged ≥15 years and...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier España
2016-01-01
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| Series: | Neurología (English Edition) |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2173580815001480 |
| _version_ | 1818476394270687232 |
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| author | M.I. Morales Casado F. Moreno Alonso A.L. Juárez Belaunde E. Heredero Gálvez O. Talavera Encinas A. Julián-Jiménez |
| author_facet | M.I. Morales Casado F. Moreno Alonso A.L. Juárez Belaunde E. Heredero Gálvez O. Talavera Encinas A. Julián-Jiménez |
| author_sort | M.I. Morales Casado |
| collection | DOAJ |
| description | Introduction: The aim of this study was to analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis and predicting bacteraemia. Methods: Prospective, observational, and descriptive analytical study of 98 consecutive patients aged ≥15 years and diagnosed with acute meningitis in an emergency department between August 2009 and July 2013. Results: We analysed 98 patients with AM (66 males [67%]); mean age was 44 ± 21 years. The diagnosis was bacterial meningitis in 38 patients (20 with bacteraemia); viral meningitis in 33; probable viral meningitis in 15; and presumptively diagnosed partially treated acute meningitis in 12. PCT had the highest area under the ROC curve (AUC) (0.996; 95% CI, 0.987–1; P < .001). With a cutoff of ≥0.74 ng/ml, PCT achieved 94.7% sensitivity, 100% specificity, negative predictive value (NPV) of 93.9%, and positive predictive value (PPV) of 100%. The mean levels for PCT were11.47 ± 7.76 ng/ml in bacterial meningitis vs 0.10 ± 0.15 ng/ml in viral meningitis (P < .001). The AUC for CRP was 0.916 and a cutoff of ≥90 mg/L achieved 67.5% sensitivity, 86.3% specificity, PPV of 89.2%, and NPV of 90.4%.As a predictor of bacteraemia in bacterial meningitis, only PCT delivered a significant difference (14.7 ± 7.1 ng/mL vs 4.68 ± 3.54 ng/mL, P < .001). A cutoff of ≥1.1 ng/mL achieved 94.6% sensitivity, 72.4% specificity, NPV of 95.4%, and PPV of 69.2%; the AUC was 0.965 (95% CI, 0.921–1; P < .001). Conclusions: PCT has a high diagnostic power for acute meningitis in emergency department patients. PCT outperforms CRP in the detection of bacterial aetiology and is a good predictor of bacteraemia in bacterial meningitis. Resumen: Introducción: El objetivo del estudio fue analizar y comparar la capacidad de la procalcitonina (PCT) y proteína C reactiva (PCR) para detectar meningitis bacteriana (MB) y para predecir la existencia de bacteriemia. Métodos: Estudio observacional, prospectivo, descriptivo y analítico de pacientes adultos (≥15 años) diagnosticados de meningitis aguda (MA) en un servicio de urgencias (SU) desde agosto de 2009 hasta julio de 2013. Resultados: Se incluyeron 98 casos diagnosticados de MA con una edad media de 44 ± 21 años, el 67% varones (66). De ellos 38 fueron MB (20 con bacteriemia), 33 meningitis virales (MV), 15 probable MV y 12 posibles MA decapitadas. La PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,996 (IC 95%:0,987–1, p < 0,001) y con un punto de corte ≥ 0,74 ng/ml se consigue una sensibilidad del 94,7%, especificidad del 100%, un VPN de 93,9% y un VPP del 100%. Los valores medios al comparar la PCT en MB y MV fueron 11,47 ± 7,76 vs. 0,10 ± 0,15 ng/ml, p < 0,001. La PCR consigue un ABC-ROC de 0,916 y con punto de corte ≥ 90 mg/L una sensibilidad de 67,5%, especificidad de 86,3%, VPP 89,2% y VPN: 90,4%.Para la predicción de bacteriemia en las MB solo la PCT consigue diferencias significativas (14,7 ± 7,1 vs. 4,68 ± 3,54 ng/ml, p < 0,001) y con un PC de 1,1 ng/ml una sensibilidad de 94,6%, especificidad 72,4%, VPN 95,4% y VPP 69,2% y un ABC de 0,965 (IC 95%: 0,921–1, p < 0,001). Conclusiones: En los pacientes con MA en SU la PCT consigue un gran rendimiento diagnóstico para sospechar la etiología bacteriana, mayor que la PCR, y para predecir la existencia de bacteriemia en las MB. Keywords: Procalcitonin, C-reactive protein, Biomarkers, Acute meningitis, Bacteraemia, Emergency department, Palabras clave: Procalcitonina, Proteína C reactiva, Biomarcadores, Meningitis aguda, Bacteriemia, Servicio de Urgencias |
| first_indexed | 2024-12-10T09:24:59Z |
| format | Article |
| id | doaj.art-c04c45b5c36c4c898cdbab68d3e34cf4 |
| institution | Directory Open Access Journal |
| issn | 2173-5808 |
| language | English |
| last_indexed | 2024-12-10T09:24:59Z |
| publishDate | 2016-01-01 |
| publisher | Elsevier España |
| record_format | Article |
| series | Neurología (English Edition) |
| spelling | doaj.art-c04c45b5c36c4c898cdbab68d3e34cf42022-12-22T01:54:33ZengElsevier EspañaNeurología (English Edition)2173-58082016-01-01311917Ability of procalcitonin to predict bacterial meningitis in the emergency departmentM.I. Morales Casado0F. Moreno Alonso1A.L. Juárez Belaunde2E. Heredero Gálvez3O. Talavera Encinas4A. Julián-Jiménez5Servicio de Neurología, Complejo Hospitalario de Toledo, Toledo, SpainServicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, SpainServicio de Neurología, Complejo Hospitalario de Toledo, Toledo, SpainServicio de Microbiología, Complejo Hospitalario de Toledo, Toledo, SpainServicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, SpainServicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, Spain; Corresponding author.Introduction: The aim of this study was to analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis and predicting bacteraemia. Methods: Prospective, observational, and descriptive analytical study of 98 consecutive patients aged ≥15 years and diagnosed with acute meningitis in an emergency department between August 2009 and July 2013. Results: We analysed 98 patients with AM (66 males [67%]); mean age was 44 ± 21 years. The diagnosis was bacterial meningitis in 38 patients (20 with bacteraemia); viral meningitis in 33; probable viral meningitis in 15; and presumptively diagnosed partially treated acute meningitis in 12. PCT had the highest area under the ROC curve (AUC) (0.996; 95% CI, 0.987–1; P < .001). With a cutoff of ≥0.74 ng/ml, PCT achieved 94.7% sensitivity, 100% specificity, negative predictive value (NPV) of 93.9%, and positive predictive value (PPV) of 100%. The mean levels for PCT were11.47 ± 7.76 ng/ml in bacterial meningitis vs 0.10 ± 0.15 ng/ml in viral meningitis (P < .001). The AUC for CRP was 0.916 and a cutoff of ≥90 mg/L achieved 67.5% sensitivity, 86.3% specificity, PPV of 89.2%, and NPV of 90.4%.As a predictor of bacteraemia in bacterial meningitis, only PCT delivered a significant difference (14.7 ± 7.1 ng/mL vs 4.68 ± 3.54 ng/mL, P < .001). A cutoff of ≥1.1 ng/mL achieved 94.6% sensitivity, 72.4% specificity, NPV of 95.4%, and PPV of 69.2%; the AUC was 0.965 (95% CI, 0.921–1; P < .001). Conclusions: PCT has a high diagnostic power for acute meningitis in emergency department patients. PCT outperforms CRP in the detection of bacterial aetiology and is a good predictor of bacteraemia in bacterial meningitis. Resumen: Introducción: El objetivo del estudio fue analizar y comparar la capacidad de la procalcitonina (PCT) y proteína C reactiva (PCR) para detectar meningitis bacteriana (MB) y para predecir la existencia de bacteriemia. Métodos: Estudio observacional, prospectivo, descriptivo y analítico de pacientes adultos (≥15 años) diagnosticados de meningitis aguda (MA) en un servicio de urgencias (SU) desde agosto de 2009 hasta julio de 2013. Resultados: Se incluyeron 98 casos diagnosticados de MA con una edad media de 44 ± 21 años, el 67% varones (66). De ellos 38 fueron MB (20 con bacteriemia), 33 meningitis virales (MV), 15 probable MV y 12 posibles MA decapitadas. La PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,996 (IC 95%:0,987–1, p < 0,001) y con un punto de corte ≥ 0,74 ng/ml se consigue una sensibilidad del 94,7%, especificidad del 100%, un VPN de 93,9% y un VPP del 100%. Los valores medios al comparar la PCT en MB y MV fueron 11,47 ± 7,76 vs. 0,10 ± 0,15 ng/ml, p < 0,001. La PCR consigue un ABC-ROC de 0,916 y con punto de corte ≥ 90 mg/L una sensibilidad de 67,5%, especificidad de 86,3%, VPP 89,2% y VPN: 90,4%.Para la predicción de bacteriemia en las MB solo la PCT consigue diferencias significativas (14,7 ± 7,1 vs. 4,68 ± 3,54 ng/ml, p < 0,001) y con un PC de 1,1 ng/ml una sensibilidad de 94,6%, especificidad 72,4%, VPN 95,4% y VPP 69,2% y un ABC de 0,965 (IC 95%: 0,921–1, p < 0,001). Conclusiones: En los pacientes con MA en SU la PCT consigue un gran rendimiento diagnóstico para sospechar la etiología bacteriana, mayor que la PCR, y para predecir la existencia de bacteriemia en las MB. Keywords: Procalcitonin, C-reactive protein, Biomarkers, Acute meningitis, Bacteraemia, Emergency department, Palabras clave: Procalcitonina, Proteína C reactiva, Biomarcadores, Meningitis aguda, Bacteriemia, Servicio de Urgenciashttp://www.sciencedirect.com/science/article/pii/S2173580815001480 |
| spellingShingle | M.I. Morales Casado F. Moreno Alonso A.L. Juárez Belaunde E. Heredero Gálvez O. Talavera Encinas A. Julián-Jiménez Ability of procalcitonin to predict bacterial meningitis in the emergency department Neurología (English Edition) |
| title | Ability of procalcitonin to predict bacterial meningitis in the emergency department |
| title_full | Ability of procalcitonin to predict bacterial meningitis in the emergency department |
| title_fullStr | Ability of procalcitonin to predict bacterial meningitis in the emergency department |
| title_full_unstemmed | Ability of procalcitonin to predict bacterial meningitis in the emergency department |
| title_short | Ability of procalcitonin to predict bacterial meningitis in the emergency department |
| title_sort | ability of procalcitonin to predict bacterial meningitis in the emergency department |
| url | http://www.sciencedirect.com/science/article/pii/S2173580815001480 |
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