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C-reactive protein and bacterial meningitis: a meta-analysis
L U Gerdes1, P E Jørgensen, E Nexø
1Department of Clinical Biochemistry, Aarhus University Hospital, Denmark. lugerdes@post4.tele.dk
Scandinavian Journal of Clinical and Laboratory Investigation
|November 18, 1998
Summary
C-reactive protein (CRP) tests show high accuracy in diagnosing bacterial meningitis. A negative CRP test is highly informative, but positive results are less conclusive for clinical management.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Biochemistry
Background:
- Bacterial meningitis is a serious infection requiring rapid diagnosis.
- C-reactive protein (CRP) is a biomarker used in diagnosing infections.
- The diagnostic accuracy of CRP in meningitis needs comprehensive evaluation.
Purpose of the Study:
- To review published literature on the diagnostic accuracy of C-reactive protein (CRP) tests.
- To assess CRP's accuracy in cerebrospinal fluid (CSF) and serum for bacterial meningitis diagnosis.
- To analyze inter-study variability in CRP diagnostic accuracy.
Main Methods:
- Systematic literature search of MEDLINE from 1980 onwards.
- Summary receiver operating characteristic curve (SROC) analyses were employed.
- Data from 35 studies involving children and adults were included.
Main Results:
- CRP tests in CSF showed an odds ratio of 241 (sensitivity 0.94, specificity 0.94).
- CRP tests in serum showed an odds ratio of 150 (sensitivity 0.92, specificity 0.92).
- Negative CRP tests provided high post-test probability (>97%) of not having meningitis.
Conclusions:
- Negative CRP tests are highly informative for ruling out bacterial meningitis.
- Positive CRP test results are less conclusive in typical clinical settings.
- The independent diagnostic value of CRP relative to other variables remains unclear, limiting conclusions on clinical usefulness.