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Predictive factors of bacterial meningitis in the patients seen in emergency departments

María Isabel Morales-Casado1, Agustín Julián-Jiménez2, Paula Lobato-Casado1

  • 1Servicio de Neurología, Complejo Hospitalario de Toledo, Toledo, España.

Enfermedades Infecciosas Y Microbiologia Clinica
|March 21, 2016
PubMed
Abstract

Insights

Predicting bacterial meningitis in emergency departments is crucial. Key indicators like cerebrospinal fluid lactate and serum procalcitonin levels can accurately identify bacterial meningitis in acute meningitis patients.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Acute meningitis (AM) requires rapid diagnosis to differentiate bacterial from viral causes.
  • Early identification of bacterial meningitis is critical for timely treatment and improved patient outcomes.
  • Emergency Departments (ED) are the primary point of care for patients presenting with acute meningitis symptoms.

Purpose of the Study:

  • To identify and compare predictive factors for bacterial meningitis in patients presenting to the ED with acute meningitis.
  • To develop a diagnostic model for bacterial meningitis using readily available clinical and laboratory data.
  • To assess the diagnostic utility of specific biomarkers in differentiating bacterial meningitis.

Main Methods:

  • A prospective, observational study involving 154 adult patients with acute meningitis seen in the ED.
  • Assessment of 32 variables including epidemiological, comorbidity, clinical, and analytical factors.
  • Multivariate logistic regression analysis to identify significant predictors of bacterial meningitis.

Main Results:

  • Bacterial meningitis was diagnosed in 53.4% of patients.
  • Four variables significantly predicted bacterial meningitis: high cerebrospinal fluid (CSF) lactate (≥33mg/dl), elevated serum procalcitonin (PCT) (≥0.8ng/ml), low CSF glucose (<60% of blood value), and increased CSF polymorphonuclears (>50%).
  • A model combining serum PCT and CSF lactate demonstrated excellent diagnostic performance with 99% sensitivity and 98% specificity (AUC 0.992).

Conclusions:

  • Serum PCT and CSF lactate levels, along with CSF glucose and polymorphonuclear counts, are highly effective in predicting bacterial meningitis during initial ED assessment.
  • These factors provide excellent diagnostic usefulness for bacterial meningitis in patients with acute meningitis.
  • The findings support the integration of these biomarkers into ED protocols for rapid bacterial meningitis diagnosis.
Keywords:
Acute meningitisBiomarcadoresBiomarkersEmergency departmentLactateLactatoMeningitis agudaProcalcitoninProcalcitoninaServicio de urgencias

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