Takemoto Kiyoshi, Yamamoto Tomonori, Hashimoto Hiroyuki, Matsuyama Takeshi, Atagi Kazuaki
Department of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan.
Department of Neurosurgery, Nara Prefecture General Medical Center, Nara, Japan.
Surg Neurol Int. 2024 Jan 26;15:26. doi: 10.25259/SNI_903_2023. eCollection 2024.
Postneurosurgical meningitis (PNM) is a serious complication in neurocritical care patients, leading to clinical deterioration and worsening outcomes. Accurate diagnosis of PNM is often difficult due to the lack of definitive diagnostic criteria. This study investigates the potential utility of cerebrospinal fluid (CSF) presepsin (PSP), blood PSP, and the CSF/blood PSP ratio as adjunctive biomarkers for the diagnosis of PNM.
We conducted a single-center prospective observational study at Nara Prefecture General Medical Center in Nara, Japan, from April 2020 to March 2022. The postoperative neurosurgical patients with suspected PNM were included in the study and divided into PNM and non-PNM groups. We evaluated the sensitivity, specificity, area under curves (AUCs), positive predictive value (PPV), and negative predictive value (NPV) for the diagnosis of PNM with CSF PSP, blood PSP, and CSF/blood PSP ratio compared in the two groups.
We screened 241 consecutive patients with postoperative neurosurgery. Diagnosis of PNM was suspected in 27 patients, and the clinical diagnosis was confirmed in nine patients. The results of CSF PSP (cutoff: 736 pg/mL) for the diagnosis of PNM were sensitivity 89%, specificity 78%, PPV 67%, NPV 93%, AUC 0.81 (95% confidence interval [CI], 0.60-1.00), blood PSP (cut-off: 264 pg/mL) was 56%, 78%, 56%, and 78%, 0.65 (95% CI, 0.42-0.88), and those of CSF/blood PSP ratio (cutoff: 3.45) was 89%, 67%, 57%, and 92%, 0.83 (95% CI, 0.65-1.00).
Elevated CSF PSP and CSF/blood PSP ratio may be associated with PNM and could serve as valuable adjunctive biomarkers for improving diagnostic accuracy.
神经外科术后脑膜炎（PNM）是神经重症监护患者的一种严重并发症，可导致临床病情恶化和预后变差。由于缺乏明确的诊断标准，PNM的准确诊断往往困难。本研究探讨脑脊液（CSF）前降钙素（PSP）、血液PSP以及CSF/血液PSP比值作为PNM诊断辅助生物标志物的潜在效用。
2020年4月至2022年3月，我们在日本奈良县综合医疗中心开展了一项单中心前瞻性观察研究。术后疑似PNM的神经外科患者纳入研究，并分为PNM组和非PNM组。我们比较了两组中CSF PSP、血液PSP以及CSF/血液PSP比值对PNM诊断的敏感性、特异性、曲线下面积（AUC）、阳性预测值（PPV）和阴性预测值（NPV）。
我们筛选了241例连续的术后神经外科患者。27例患者疑似PNM，其中9例临床诊断得到证实。CSF PSP（临界值：736 pg/mL）诊断PNM的结果为敏感性89%、特异性78%、PPV 67%、NPV 93%、AUC 0.81（95%置信区间[CI]，0.60 - 1.00）；血液PSP（临界值：264 pg/mL）分别为56%、78%、56%和78%、0.65（95%CI，0.42 - 0.88）；CSF/血液PSP比值（临界值：3.45）分别为89%、67%、57%和92%、0.83（95%CI，0.65 - 1.00）。
CSF PSP升高和CSF/血液PSP比值升高可能与PNM相关，可作为提高诊断准确性的有价值的辅助生物标志物。
