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Cerebrospinal Fluid Procalcitonin-A Potential Biomarker for Post-Craniotomy Bacterial Meningitis
Ranjith K Moorthy1, Victoria Job2, Grace Rebekah3
1Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Background:
The literature regarding the utility of cerebrospinal fluid (CSF) procalcitonin (PCT) in the diagnosis of post-craniotomy bacterial meningitis and differentiating it from aseptic meningitis is sparse.
Materials And Methods:
CSF total WBC count, sugar, protein, and PCT were measured in febrile patients with suspected post-craniotomy meningitis during the first 30 days following an intradural cranial procedure for non-trauma indications. Patients were diagnosed as postoperative bacterial meningitis if CSF culture was positive (PBM, n = 28) or postoperative aseptic meningitis if CSF culture was sterile and there was no evidence of systemic infection (PAM, n = 31). CSF cytochemical parameters and PCT values were compared between the groups. Normal values of CSF PCT were obtained from 14 patients with noninfectious indications with hydrocephalus.
Results:
There was no significant difference in CSF total WBC count, sugar, and protein levels between PAM and PBM groups. The median PCT level in CSF in the normal group was 0.03 ng/mL (interquartile range [IQR] 0.02-0.07 ng/mL). CSF PCT in the PBM group (median 0.37 ng/mL, IQR 0.2-1.4 ng/mL) was significantly higher than normal values as well as PAM group (median 0.12 ng/mL, IQR 0.07-0.26 ng/mL (P = 0.0004). The area under the receiver operating characteristic (ROC) curve for CSF PCT was 0.767. A cutoff value of 0.12 ng/mL yielded a sensitivity of 85.7% (95% CI: 67.3% to 96%), specificity of 51.6% (95% CI: 33% to 69.9%), positive predictive value of 61.5% (95% CI: 51.9% to 70.3%), and negative predictive value of 80% (95% CI: 60.3.8% to 91.3%).
Conclusions:
CSF PCT assay in patients who are febrile during the first 30 days post-non-trauma neurosurgical procedures has a role in the early diagnosis of bacterial meningitis.
Insights
Cerebrospinal fluid procalcitonin (PCT) aids in early diagnosis of bacterial meningitis after non-trauma neurosurgery. Elevated CSF PCT levels help differentiate bacterial meningitis from aseptic meningitis in febrile patients.
Area of Science:
- Neuroscience
- Infectious Diseases
- Clinical Diagnostics
Background:
- Limited literature exists on cerebrospinal fluid (CSF) procalcitonin (PCT) utility for diagnosing post-craniotomy bacterial meningitis.
- Differentiating bacterial meningitis from aseptic meningitis post-craniotomy requires improved diagnostic markers.
Purpose of the Study:
- To evaluate the role of CSF procalcitonin (PCT) in diagnosing bacterial meningitis in febrile patients following non-trauma craniotomy.
- To compare CSF PCT levels between postoperative bacterial meningitis (PBM) and postoperative aseptic meningitis (PAM) groups.
Main Methods:
- CSF samples were analyzed for white blood cell (WBC) count, sugar, protein, and PCT in febrile patients within 30 days post-craniotomy.
- Patients were classified as PBM (positive CSF culture) or PAM (sterile CSF culture, no systemic infection).
- CSF cytochemical parameters and PCT values were compared between groups; normal PCT values were established from a control group.
Main Results:
- CSF total WBC count, sugar, and protein levels did not significantly differ between PAM and PBM groups.
- CSF PCT levels were significantly higher in the PBM group (median 0.37 ng/mL) compared to both the normal group (median 0.03 ng/mL) and the PAM group (median 0.12 ng/mL).
- A CSF PCT cutoff of 0.12 ng/mL showed 85.7% sensitivity and 51.6% specificity for diagnosing bacterial meningitis.
Conclusions:
- CSF PCT assay is valuable for the early diagnosis of bacterial meningitis in febrile patients within 30 days after non-trauma neurosurgical procedures.
- CSF PCT can assist in differentiating bacterial meningitis from aseptic meningitis in the early postoperative period.
