Cerebrospinal Procalcitonin for Diagnosing Meningitis in Infants Less Than 90 Days: A Systematic Review and...

Early identification and treatment of meningitis in early infancy is crucial for improved outcomes. However, the commonly used cerebrospinal fluid (CSF) markers for diagnosing meningitis have poor diagnostic accuracy.

To assess the diagnostic utility of CSF procalcitonin for diagnosing meningitis in infants with postnatal age less than 90 days.

We searched databases, including MEDLINE, Embase, and Scopus, from inception to 15 March 2025. We included observational studies that used CSF procalcitonin as a marker for diagnosing meningitis in infants with a postnatal age of less than 90 days. The risk of bias was assessed using the QUADAS-2, and the certainty of evidence was ascertained using GRADE approach. The bivariate random effect model and hierarchical summary receiver operating characteristic meta-analysis were used to pool data with multiple thresholds.

Out of 815 retrieved records, seven studies involving 963 infants were included in the meta-analysis. We obtained diagnostic accuracy measures at commonly used threshold cut-offs of 0.20 ng/mL and 0.33 ng/mL. At a CSF procalcitonin threshold cut-off of 0.20 ng/mL, the pooled sensitivity (95%CI) was 77.1% (49.2%, 92.1%), and the pooled specificity (95%CI) was 68.9% (49.2%, 83.5%). At a cut-off of 0.33 ng/mL, sensitivity was 75.8% (50.1%, 90.7%) and specificity was 75.1% (58.5%, 86.6%). The certainty of evidence remained very low for both sensitivity and specificity.

CSF procalcitonin has moderate sensitivity and specificity for diagnosing meningitis in infants with postnatal age < 90 days. However, wide confidence intervals and very low certainty of evidence limit the reliability of these findings.