Hellenic National Meningitis Reference Laboratory, Department of Public Health, National School of Public Health, Athens, Greece.
AAP, The Johns Hopkins University, 3400 North Charles Street, Wyman Park Building S 612, Baltimore, MD, 21218, USA.
Eur J Clin Microbiol Infect Dis. 2017 Sep;36(9):1553-1557. doi: 10.1007/s10096-017-2967-y. Epub 2017 Mar 24.
Cerebrospinal fluid (CSF) neutrophil counts and neutrophil-to-lymphocyte ratio (NLR) are useful in distinguishing bacterial and viral meningitis. Given that meningitis is clinically heterogeneous with regard to age, here we investigated the validity of the CSF NLR and neutrophil assay according to age group. Data from the nationwide referral of >4,000 meningitis cases to the Hellenic Meningitis Reference Laboratory between 2006 and 2013 were examined. CSF NLR and neutrophil counts were stratified according to age, and assay performance was determined using previous cut-off values of 2 and 287 cells/μl for CSF NLR and neutrophils respectively. The distribution of bacterial versus viral meningitis was heterogenous across age groups, with a low proportion of bacterial meningitis in patients aged 5-14. CSF neutrophil count and NLR were significantly more discriminatory for bacterial meningitis in patients aged over 14 years than those aged 0-14. The odds ratio (OR), sensitivity, specificity and positive predictive value (PPV) were significantly higher in older patients for both biomarkers. When combined, the false-positive and false-negative detection of bacterial meningitis was 3.9 and 8.5% respectively, and the OR of 262.2 was 2.5-fold greater than expected from a multiplicative effect alone in patients aged >14 years. Care is required when applying diagnostic tests for meningitis in different age groups because of patient heterogeneity. This is the first description of the age distribution of meningitis cases in Greece, and knowledge of the age-related distribution of neutrophils and NLR in meningitis cases could help towards developing age-specific meningitis diagnostic assays.
脑脊液（CSF）中性粒细胞计数和中性粒细胞与淋巴细胞比值（NLR）有助于区分细菌性和病毒性脑膜炎。鉴于脑膜炎在年龄方面具有临床异质性，因此我们在此根据年龄组研究了 CSF NLR 和中性粒细胞检测的有效性。对 2006 年至 2013 年期间向希腊脑膜炎参考实验室转诊的>4000 例脑膜炎病例进行了全国性调查。根据年龄对 CSF NLR 和中性粒细胞计数进行分层，并使用 CSF NLR 和中性粒细胞的先前临界值 2 和 287 个细胞/μl 分别确定检测性能。细菌性与病毒性脑膜炎在年龄组之间的分布存在差异，5-14 岁患者中细菌性脑膜炎的比例较低。在>14 岁的患者中，CSF 中性粒细胞计数和 NLR 对细菌性脑膜炎的区分度明显高于 0-14 岁的患者。对于这两种生物标志物，年龄较大的患者的优势比（OR）、敏感性、特异性和阳性预测值（PPV）均明显更高。当联合使用时，细菌性脑膜炎的假阳性和假阴性检出率分别为 3.9%和 8.5%，并且>14 岁患者的 OR 比单独乘法效应预计的 262.2 高 2.5 倍。由于患者异质性，在不同年龄组中应用脑膜炎诊断检测时需要谨慎。这是希腊脑膜炎病例年龄分布的首次描述，了解脑膜炎病例中性粒细胞和 NLR 的年龄相关分布有助于开发针对特定年龄的脑膜炎诊断检测。
