Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
J Transl Med. 2023 Sep 7;21(1):603. doi: 10.1186/s12967-023-04485-w.
The early differential diagnosis between bacterial meningitis (BM) and tuberculous meningitis (TBM) or cryptococcal meningitis (CM) remains a significant clinical challenge. Neutrophil Gelatinase-Associated Lipocalin (NGAL) has been reported as a novel inflammatory biomarker in the early stages of infection. This study aimed to investigate whether cerebrospinal fluid (CSF) NGAL can serve as a potential biomarker for distinguishing between BM and TBM or CM.
We prospectively enrolled the patients with suspected CNS infections at admission and divided them into three case groups: BM (n = 67), TBM (n = 55), CM (n = 51), and an age- and sex-matched hospitalized control (HC, n = 58). Detected the CSF NGAL and assessed its diagnostic accuracy in distinguishing between BM and TBM or CM. Additionally, longitudinally measured the CSF NGAL levels in patients with BM to evaluate its potential as a monitoring tool for antibacterial treatment.
The concentration of CSF NGAL in BM was significantly higher than in TBM, CM, and HC (all P < 0.05), while the serum NGAL did not show significant differences among the three case groups. The ROC analysis demonstrated that CSF NGAL presented a good diagnostic performance with an AUC of 0.834 (0.770-0.886) and at the optimal cutoff value of 74.27 ng/mL with 70.15% sensitivity and 77.36% specificity for discriminating BM with TBM and CM. Additionally, the CSF NGAL in the convalescent period of BM was significantly lower than in the acute period (P < 0.05).
CSF NGAL may serve as a potential biomarker for distinguishing between acute BM and TBM or CM. Additionally, it holds clinical significance in monitoring the effectiveness of antibiotic therapy for BM.
细菌性脑膜炎（BM）与结核性脑膜炎（TBM）或隐球菌性脑膜炎（CM）的早期鉴别诊断仍然是一个重大的临床挑战。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）已被报道为感染早期的一种新型炎症生物标志物。本研究旨在探讨脑脊液（CSF）NGAL 是否可作为鉴别 BM 与 TBM 或 CM 的潜在生物标志物。
我们前瞻性纳入入院时疑似中枢神经系统感染的患者，并将其分为三组病例：BM（n=67）、TBM（n=55）、CM（n=51）和年龄及性别匹配的住院对照组（HC，n=58）。检测 CSF NGAL，并评估其在鉴别 BM 与 TBM 或 CM 中的诊断准确性。此外，对 BM 患者进行 CSF NGAL 的纵向测量，以评估其作为抗菌治疗监测工具的潜力。
BM 患者的 CSF NGAL 浓度明显高于 TBM、CM 和 HC（均 P<0.05），而血清 NGAL 在三组病例中无显著差异。ROC 分析表明，CSF NGAL 具有良好的诊断性能，AUC 为 0.834（0.770-0.886），最佳截断值为 74.27ng/mL，对鉴别 BM 与 TBM 和 CM 的敏感性为 70.15%，特异性为 77.36%。此外，BM 患者的 CSN NGAL 在恢复期明显低于急性期（P<0.05）。
CSF NGAL 可能作为鉴别急性 BM 与 TBM 或 CM 的潜在生物标志物。此外，其在监测 BM 抗生素治疗效果方面具有临床意义。
