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Diagnostic Test Accuracy of Serum and Cerebrospinal Fluid C-Reactive Protein in Bacterial Meningitis: A Systematic
Shreya Singh1, Kamleshwar Mahto2, Amit Kumar3
1Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Background:
Bacterial meningitis is a serious infection leading to increased morbidity and mortality every year due to delayed diagnosis and treatment. Previous literatures had shown that cerebrospinal fluid (CSF) procalcitonin outweighs serum procalcitonin to diagnose bacterial infections of the central nervous system. Current meta-analysis aims to find the diagnostic accuracy of serum and CSF C-reactive protein (CRP) to diagnose bacterial meningitis.
Material And Methods:
PubMed, Google Scholar, Cochrane Library and Google databases were searched from 1st January 1980 to 30th June 2022. Observational studies, prospective or retrospective focusing on C-reactive protein as a biomarker for bacterial meningitis in adult patients were searched. The articles related to serum and CSF CRP for diagnosing bacterial meningitis were explored and retrieved separately, by two independent experts from the published studies available in the electronic search engines. The risk of bias and scholarly quality of studies were evaluated by QUADAS-2.
Results:
Altogether 637 articles were recognized, out of which 22 studies selected. CSF CRP has shown better diagnostic value than serum CRP. Pooled sensitivity of CSF CRP was 0.89 (95% confidence interval [CI], 0.81-0.94), specificity 0.96 (95% CI, 0.92-0.97), area under the curve (AUC) 0.98 (95% CI, 0.96-0.99), diagnostic odds ratio (DOR) 175 (95% CI, 74-410), positive likelihood ratio (PLR) 20 (95% CI, 11.5-34.1) and negative likelihood ratio (NLR) 0.11 (95% CI, 0.06-0.21). While, pooled sensitivity of serum CRP was 0.80 (95% CI, 0.69-0.88), specificity 0.86 (95% CI, 0.74-0.93), AUC 0.89 (95% CI, 0.86-0.92), DOR 24 (95% CI, 9-62), PLR 6 (95% CI, 2.9-10.7) and NLR 0.23 (95% CI, 0.15-0.37). Heterogeneity was higher for serum CRP than CSF CRP.
Conclusion:
Our meta-analysis shows that CSF CRP had higher pooled sensitivity, specificity and PLR along with higher AUC and DOR for confirming bacterial meningitis in adults than serum CRP.
Insights
Cerebrospinal fluid (CSF) C-reactive protein (CRP) is a more accurate biomarker than serum CRP for diagnosing bacterial meningitis in adults. This meta-analysis confirms CSF CRP
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Biomarker Research
Background:
- Bacterial meningitis poses significant morbidity and mortality risks globally.
- Timely diagnosis and treatment are crucial for improving patient outcomes.
- Cerebrospinal fluid (CSF) procalcitonin shows diagnostic promise over serum procalcitonin for CNS infections.
Purpose of the Study:
- To evaluate the diagnostic accuracy of serum and CSF C-reactive protein (CRP) for bacterial meningitis.
- To compare the efficacy of CSF CRP versus serum CRP in diagnosing bacterial meningitis.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Google Scholar, Cochrane Library, and Google databases (January 1980 - June 2022).
- Included observational studies (prospective/retrospective) on adult patients using CRP for bacterial meningitis diagnosis.
- Risk of bias and quality assessed using QUADAS-2; data extracted by two independent experts.
Main Results:
- CSF CRP demonstrated superior diagnostic accuracy compared to serum CRP.
- Pooled sensitivity for CSF CRP was 0.89, specificity 0.96, and AUC 0.98.
- Serum CRP showed pooled sensitivity of 0.80, specificity of 0.86, and AUC 0.89; higher heterogeneity observed for serum CRP.
Conclusions:
- CSF CRP exhibits higher pooled sensitivity, specificity, and positive likelihood ratio (PLR) than serum CRP for diagnosing bacterial meningitis in adults.
- CSF CRP also achieved a higher area under the curve (AUC) and diagnostic odds ratio (DOR), indicating greater diagnostic value.
