Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Crit Care. 2022 Mar 8;26(1):56. doi: 10.1186/s13054-022-03929-x.
The sensitive and accurate diagnosis of nosocomial meningitis and ventriculitis is still a critical problem. This study was designed to explore the diagnostic value of cerebrospinal fluid heparin-binding protein (HBP) in nosocomial meningitis and ventriculitis in comparison with procalcitonin and lactate.
In this observational study, 323 suspected patients were enrolled, of which 42 participants were excluded because they could not be accurately grouped, 131 subjects who were eventually diagnosed with nosocomial meningitis or ventriculitis and 150 patients in whom infection was ultimately ruled out were included in the final analysis. The main results are expressed as medians (interquartile ranges). The Chi-squared test was used to compare the baseline characteristics. The Mann-Whitney U-test was used for group and subgroup analyses. The area under the receiver operating characteristic curve was calculated to describe the diagnostic accuracy of the biomarkers. Spearman's partial correlation was used to analyze associations between the biomarkers. Statistical significance was set when p value < 0.05.
HBP achieved the largest area under the receiver operating characteristic curve, which was 0.99 (95% confidence interval 0.98-1.00) compared with 0.98 (95% confidence interval 0.96-0.99) for lactate and 0.69 (95% confidence interval 0.62-0.75) for procalcitonin. With a cutoff level at 23 ng/mL, HBP achieved a sensitivity of 97%, a specificity of 95%, a positive predictive value of 93% and a negative predictive value of 98%. The levels of HBP presented no significant discrepancy between patients who received previous empiric anti-infective therapy and those who did not (p > 0.05). Higher concentrations of HBP were present in patients with positive microbiological findings (p < 0.05). Levels of HBP positively correlated with polymorphonuclear cell count (Spearman's rho = 0.68, p < 0.01), white blood cell count (Spearman's rho = 0.57, p < 0.01) and lactate (Spearman's rho = 0.34, p < 0.01).
Cerebrospinal fluid heparin-binding protein is a reliable auxiliary diagnostic marker that is preferable over lactate and procalcitonin in identifying nosocomial meningitis and ventriculitis, and it also contributes to solving the diagnostic difficulties caused by empiric antibiotherapy.
医院获得性脑膜炎和脑室炎的敏感、准确诊断仍然是一个关键问题。本研究旨在探讨脑脊液肝素结合蛋白（HBP）在医院获得性脑膜炎和脑室炎诊断中的价值，并与降钙素原和乳酸进行比较。
本观察性研究纳入了 323 例疑似患者，其中 42 例因无法准确分组而被排除，最终纳入了 131 例确诊为医院获得性脑膜炎或脑室炎的患者和 150 例感染最终排除的患者。主要结果以中位数（四分位距）表示。采用卡方检验比较基线特征。采用 Mann-Whitney U 检验进行组间和亚组分析。计算受试者工作特征曲线下面积以描述生物标志物的诊断准确性。采用斯皮尔曼偏相关分析生物标志物之间的相关性。当 p 值<0.05 时，认为差异具有统计学意义。
HBP 获得的受试者工作特征曲线下面积最大，为 0.99（95%置信区间 0.98-1.00），乳酸为 0.98（95%置信区间 0.96-0.99），降钙素原为 0.69（95%置信区间 0.62-0.75）。当截断值为 23 ng/mL 时，HBP 的灵敏度为 97%，特异性为 95%，阳性预测值为 93%，阴性预测值为 98%。接受过经验性抗感染治疗的患者与未接受过经验性抗感染治疗的患者的 HBP 水平无显著差异（p>0.05）。阳性微生物学发现的患者 HBP 浓度较高（p<0.05）。HBP 水平与多形核白细胞计数（斯皮尔曼 rho=0.68，p<0.01）、白细胞计数（斯皮尔曼 rho=0.57，p<0.01）和乳酸（斯皮尔曼 rho=0.34，p<0.01）呈正相关。
脑脊液肝素结合蛋白是一种可靠的辅助诊断标志物，在识别医院获得性脑膜炎和脑室炎方面优于乳酸和降钙素原，并且有助于解决经验性抗生素治疗引起的诊断困难。
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