Morales Casado M I, Moreno Alonso F, Juárez Belaunde A L, Heredero Gálvez E, Talavera Encinas O, Julián-Jiménez A
Servicio de Neurología, Complejo Hospitalario de Toledo, Toledo, España.
Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España.
Neurologia. 2016 Jan-Feb;31(1):9-17. doi: 10.1016/j.nrl.2014.07.003. Epub 2014 Oct 5.
The aim of this study was to analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis and predicting bacteraemia.
Prospective, observational, and descriptive analytical study of 98 consecutive patients aged ≥15 years and diagnosed with acute meningitis in an emergency department between August 2009 and July 2013.
We analysed 98 patients with AM (66 males [67%]); mean age was 44±21 years. The diagnosis was bacterial meningitis in 38 patients (20 with bacteraemia); viral meningitis in 33; probable viral meningitis in 15; and presumptively diagnosed partially treated acute meningitis in 12. PCT had the highest area under the ROC curve (AUC) (0.996; 95% CI, 0.987-1; p<0.001). With a cutoff of ≥ 0.74 ng/ml, PCT achieved 94.7% sensitivity, 100% specificity, negative predictive value (NPV) of 93.9%, and positive predictive value (PPV) of 100%. The mean levels for PCT were11.47±7.76 ng/ml in bacterial meningitis vs. 0.10±0.15 ng/ml in viral meningitis (p <0.001). The AUC for CRP was 0.916 and a cutoff of ≥ 90 mg/L achieved 67.5% sensitivity, 86.3% specificity, PPV of 89.2%, and NPV of 90.4%. As a predictor of bacteraemia in bacterial meningitis, only PCT delivered a significant difference (14.7±7.1 ng/mL vs. 4.68±3.54 ng/mL, p<0.001). A cutoff of ≥ 1.1 ng/mL achieved 94.6% sensitivity, 72.4% specificity, NPV of 95.4%, and PPV of 69.2%; the AUC was 0.965 (95% CI, 0.921-1; p<0.001).
PCT has a high diagnostic power for acute meningitis in emergency department patients. PCT outperforms CRP in the detection of bacterial aetiology and is a good predictor of bacteraemia in bacterial meningitis.
本研究旨在分析和比较降钙素原（PCT）和C反应蛋白（CRP）作为检测细菌性脑膜炎及预测菌血症的工具。
对2009年8月至2013年7月期间在急诊科连续收治的98例年龄≥15岁且诊断为急性脑膜炎的患者进行前瞻性、观察性和描述性分析研究。
我们分析了98例急性脑膜炎患者（66例男性[67%]）；平均年龄为44±21岁。诊断为细菌性脑膜炎的有38例（20例伴有菌血症）；病毒性脑膜炎33例；可能的病毒性脑膜炎15例；推测诊断为部分治疗的急性脑膜炎12例。PCT的ROC曲线下面积（AUC）最高（0.996；95%CI，0.987 - 1；p<0.001）。截断值≥0.74 ng/ml时，PCT的灵敏度为94.7%，特异度为100%，阴性预测值（NPV）为93.9%，阳性预测值（PPV）为100%。细菌性脑膜炎患者PCT的平均水平为11.47±7.76 ng/ml，而病毒性脑膜炎患者为0.10±0.15 ng/ml（p<0.001）。CRP的AUC为0.916，截断值≥90 mg/L时，灵敏度为67.5%，特异度为86.3%，PPV为89.2%，NPV为90.4%。作为细菌性脑膜炎菌血症的预测指标，只有PCT有显著差异（14.7±7.1 ng/mL对4.68±3.54 ng/mL，p<0.001）。截断值≥1.1 ng/mL时，灵敏度为94.6%，特异度为72.4%，NPV为95.4%，PPV为69.2%；AUC为0.965（95%CI，0.921 - 1；p<0.001）。
PCT对急诊科患者的急性脑膜炎具有较高的诊断效能。在检测细菌性病因方面，PCT优于CRP，并且是细菌性脑膜炎菌血症的良好预测指标。
