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Cerebrospinal Procalcitonin for Diagnosing Meningitis in Infants Less Than 90 Days: A Systematic Review and
Vijay Kumar Krishnegowda1, Prathik Bandiya2, Debasish Nanda3
1Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India. vijaykumark@soa.ac.in.
Context:
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.
Objective:
To assess the diagnostic utility of CSF procalcitonin for diagnosing meningitis in infants with postnatal age less than 90 days.
Evidence Acquisition:
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.
Results:
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.
Conclusion:
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.
Insights
Cerebrospinal fluid (CSF) procalcitonin shows moderate accuracy for diagnosing infant meningitis. However, very low certainty of evidence limits the reliability of these findings for early diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Diagnostic Medicine
Background:
- Early diagnosis and treatment of meningitis in infants are critical for better outcomes.
- Current cerebrospinal fluid (CSF) markers for meningitis diagnosis lack sufficient accuracy.
- Infant meningitis requires reliable diagnostic tools for timely intervention.
Purpose of the Study:
- To evaluate the diagnostic utility of CSF procalcitonin for identifying meningitis in infants younger than 90 days.
- To assess the sensitivity and specificity of CSF procalcitonin as a biomarker for infant meningitis.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, Embase, Scopus) up to March 2025.
- Seven observational studies involving 963 infants were included in a meta-analysis.
- Diagnostic accuracy was assessed using bivariate random-effects and hierarchical summary ROC models, with risk of bias evaluated by QUADAS-2 and certainty of evidence by GRADE.
Main Results:
- At a CSF procalcitonin cut-off of 0.20 ng/mL, pooled sensitivity was 77.1% and specificity was 68.9%.
- At a cut-off of 0.33 ng/mL, pooled sensitivity was 75.8% and specificity was 75.1%.
- The certainty of evidence for both sensitivity and specificity was determined to be very low.
Conclusions:
- CSF procalcitonin demonstrates moderate sensitivity and specificity for diagnosing meningitis in infants under 90 days.
- Wide confidence intervals and very low certainty of evidence restrict the conclusive interpretation of these diagnostic accuracy findings.
- Further high-quality research is needed to confirm the utility of CSF procalcitonin in diagnosing infant meningitis.
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