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Published on: June 28, 2018
Heparin-Binding Protein as a Diagnostic Biomarker for Healthcare-Associated Meningitis and Ventriculitis in Pediatric
Yueyue Kong1, Jiahao Niu2, Zhiming Liu3
1Department of Critical Care Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing , China.
Insights
Cerebrospinal fluid (CSF) heparin-binding protein (HBP) shows superior accuracy in diagnosing pediatric healthcare-associated meningitis or ventriculitis compared to lactate and procalcitonin (PCT). Early HBP testing aids in prompt detection of these serious CSF infections.
Area of Science:
- Neuroscience
- Infectious Diseases
- Biomarker Discovery
Background:
- Diagnosing meningitis and ventriculitis post-craniotomy in children is challenging.
- Healthcare-associated infections of the central nervous system require timely and accurate diagnostic methods.
Purpose of the Study:
- To evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) heparin-binding protein (HBP) for healthcare-associated meningitis or ventriculitis in pediatric patients.
- To compare the efficacy of HBP against lactate and procalcitonin (PCT) in diagnosing these post-craniotomy infections.
Main Methods:
- A prospective observational cohort study included children undergoing craniotomy for ventricular system tumors.
- CSF samples were analyzed for HBP, lactate, PCT, white blood cell count, glucose, protein, Gram staining, and cultures when CSF infection was suspected.
Main Results:
- Heparin-binding protein (HBP) levels were significantly higher in infected patients (180 ng/mL) versus controls (12 ng/mL).
- HBP demonstrated the highest diagnostic accuracy (AUC 0.93), sensitivity (89%), and specificity (81%) compared to lactate (AUC 0.90) and PCT (AUC 0.66).
- HBP was the sole biomarker elevated in all culture-positive cases, unaffected by empiric antibiotics.
Conclusions:
- CSF HBP is a highly accurate biomarker for diagnosing healthcare-associated meningitis and ventriculitis in pediatric patients post-craniotomy.
- HBP surpasses lactate and PCT in diagnostic performance for these specific infections.
- Early analysis of CSF HBP can facilitate earlier detection and management of CSF infections.
Background And Objectives:
Early and accurate diagnosis of meningitis and ventriculitis after craniotomy is still quite challenging. The research aimed to examine if cerebrospinal fluid (CSF) heparin-binding protein (HBP) can enhance the accuracy in diagnosing healthcare-associated meningitis or ventriculitis in children compared with lactate and procalcitonin (PCT).
Methods:
Children with craniotomy for ventricular system tumors were eligible for this prospective observational cohort study. Heparin-binding protein, PCT, white blood cell count, glucose, protein, and lactate in CSF were tested when children were suspected of developing CSF infections, as were Gram staining and cultures.
Results:
Among 122 eligible participants, 116 with 279 samples were enrolled in the final analysis, including 71 children (142 samples) with healthcare-associated meningitis or ventriculitis as the infected group and 45 children (137 samples) with no CSF infections as the control group. Heparin-binding protein presented a substantially increased pattern in patients with postoperative meningitis or ventriculitis contrasted with control patients (180 [120-212] ng/mL in the infected group vs 12 [3-58] ng/mL in the controls). Heparin-binding protein achieved the highest area under the receiver operating characteristic curve of 0.93 (95% confidence interval, 0.91-0.96), a sensitivity of 89%, a specificity of 81%, a positive predictive value of 83%, and a negative predictive value of 87% with a cutoff value of >74 ng/mL, followed by lactate (0.90 [0.87-0.94]) and PCT (0.66 [0.60-0.73]). The protein was the only biomarker that elevated significantly in all culture-positive patients without the influence of empiric antibiotics.
Conclusion:
CSF HBP is a more accurate candidate biomarker superior to lactate and PCT for diagnosing healthcare-associated meningitis and ventriculitis among pediatric patients. Early HBP analysis of CSF in suspected patients may facilitate early detection of CSF infections.
