Emergency and Intensive Care Units, North Hospital, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne Cedex 2, France.
Crit Care. 2011;15(3):R136. doi: 10.1186/cc10254. Epub 2011 Jun 6.
The objective of this study was to determine the ability of various parameters commonly used for the diagnosis of acute meningitis to differentiate between bacterial and viral meningitis, in adult patients with a negative direct cerebrospinal fluid (CSF) examination.
This was a prospective study, started in 1997, including all patients admitted to the emergency unit with acute meningitis and a negative direct CSF examination. Serum and CSF samples were taken immediately on admission. The patients were divided into two groups according to the type of meningitis: bacterial (BM; group I) or viral (VM; group II). The CSF parameters investigated were cytology, protein, glucose, and lactate; the serum parameters evaluated were C-reactive protein and procalcitonin. CSF/serum glucose and lactate ratios were also assessed.
Of the 254 patients with meningitis with a negative direct CSF examination, 35 had BM and 181, VM. The most highly discriminative parameters for the differential diagnosis of BM proved to be CSF lactate, with a sensitivity of 94%, a specificity of 92%, a negative predictive value of 99%, a positive predictive value of 82% at a diagnostic cut-off level of 3.8 mmol/L (area under the curve (AUC), 0.96; 95% confidence interval (CI), 0.95 to 1), and serum procalcitonin, with a sensitivity of 95%, a specificity of 100%, a negative predictive value of 100%, and a positive predictive value of 97% at a diagnostic cut-off level of 0.28 ng/ml (AUC, 0.99; 95% CI, 0.99 to 1).
Serum procalcitonin and CSF lactate concentrations appear to be the most highly discriminative parameters for the differential diagnosis of BM and VM.
本研究旨在确定在直接脑脊液（CSF）检查阴性的成年急性脑膜炎患者中，用于诊断细菌性和病毒性脑膜炎的各种常用参数在鉴别细菌性和病毒性脑膜炎方面的能力。
这是一项前瞻性研究，始于 1997 年，包括所有因急性脑膜炎且直接 CSF 检查阴性而入住急诊部的患者。入院时立即采集血清和 CSF 样本。根据脑膜炎类型将患者分为两组：细菌性（BM；I 组）或病毒性（VM；II 组）。研究的 CSF 参数包括细胞学、蛋白、葡萄糖和乳酸；评估的血清参数包括 C 反应蛋白和降钙素原。还评估了 CSF/血清葡萄糖和乳酸比值。
在 254 例直接 CSF 检查阴性的脑膜炎患者中，35 例为 BM，181 例为 VM。用于 BM 鉴别诊断的最具鉴别力的参数是 CSF 乳酸，其诊断截止值为 3.8mmol/L 时，其敏感性为 94%、特异性为 92%、阴性预测值为 99%、阳性预测值为 82%（曲线下面积（AUC）为 0.96；95%置信区间（CI）为 0.95 至 1），血清降钙素原的敏感性为 95%、特异性为 100%、阴性预测值为 100%和阳性预测值为 97%（诊断截止值为 0.28ng/ml 时，AUC 为 0.99；95%CI 为 0.99 至 1）。
血清降钙素原和 CSF 乳酸浓度似乎是鉴别 BM 和 VM 的最具鉴别力的参数。
