Early Differential Diagnosis Value Procalcitonin In Bacterial Meningitis In Children

Objective: Procalcitonin(PCT)has been proposed as a superior inflammatory markers to diagnosis of bacterial infection.In the present study,The levels of serum and cerebrospinal fluid(CSF)PCT in the bacterial meningitis(BM)and viral encephalitis(VE)children patients were measured.Comparing the diagnostic worth of PCT in serum and CSF with eastablished markers of infection--such as blood routine leucocyte count,serum C-reactive protein(CRP),cerebrospinal fluid leucocyte count,protein and glucouse in children with bacterial meningitis to explore the clinical value of serum and CSF PCT change of children with bacterial meningitis.Methods:(1)From June 2015 to September 2017,46 cases of bacterial meningitis in Second affiliated hospital of south China university were enrolled in this study,including 9cases with diagnosis of severe bacterial meningitis and 37 cases with diagnosis of common bacterial meningitis.84 cases of viral encephalitis as control group were enrolled.(2)All of patients had blood routine test,serum CRP examination,serum PCT test,blood culture.CSF PCT and the routine bacterial and chemical analyses of CSF(leucocyte count,protein,glucouse,culture).(3)The distribution and difference of each index parameters of each group were calculated andanalyzed.(4)The parameter of combination of serum and CSF PCT for diagnosis of bacterial meningitis in children was obtained by methods of two categories logistic regression analysis.The diagnostic performance of the serum PCT,CSF PCT,combined parameter and traditional markers were evaluated by receiver operator characteristic curve(ROC)analysis.(5)The relationnship between CSF and serum PCT levels was analyzed by Spearman's correlation analysis.Results:(1)The median PCT's concentration in serum and CSF in the BM were 3.20(< 0.05,> 200.00)ng/ml and 0.18(< 0.05,5.83)ng/ml,respectively,and they were significantly higher than those in the VE [ 0.26(< 0.05,9.33)ng/ml and < 0.05 ng/ml,respectively](P<0.05).(2)Comparing area under ROC curve(AUC),The AUC of serum PCT was highest(0.874),Using 0.42 ng/ml as the threshold,the diagnostic sensitivity and specificity of serum PCT for the diagnosis of BM were 86.4%and 82.2%,respectively.The AUC of CSF PCT was 0.839,Using 0.05 ng/ml as the threshold,the diagnostic sensitivity and specificity of CSF PCT for the diagnosis of BM were75.7 % and 99.5%,respectively.The AUC was increased to 0.942 by combining serem PCT and CSF PCT.Using 0.15 as the threshold with a sensitivity at 90.6% and specificity at 92.9%.(3)A significant positive correlation between the serum and CSF PCT levels in the BM.(R=0.667,P<0.05).(4)The median PCT's concentration in serum and CSFin the severe BM were 25.26(6.59,>200.00)ng/ml and 0.95(0.21,5.83)ng/ml,respectively,and they were significantly higher than those in the common BM [ 1.06(<0.05,103.20)ng/ml and 0.10(<0.05,0.55)ng/ml,respectively](P<0.05).Conclusion: 1.The serum and CSF PCT level is positively correlated the severity of bacterial meningitis.2.The serum PCT level may be positively correlated with the CSF PCT level in the BM.3.Serum and CSF PCT both have high diagnostic value for BM among suspected meningitis children.Combined serum and CSF PCT can have better diagnostic value than serum and CSF PCT.