Determination of diagnostic value of CRP, cortisol and pro-calcitonin of cerebrospinal fluid in differentiation of types of meningitis
Determination of diagnostic value of CRP, cortisol and pro-calcitonin of cerebrospinal fluid in differentiation of types of meningitis
Fatemeh Kourkinejad_Gharaei,1Maedeh Najafizadeh,2,*Alireza Sharif,3Alireza Moraveji,4Mahdi Rafiyan,5
1. 1Department of Infectious diseases, Emam Reza Hospital, Sirjan School of Medical Sciences, Sirjan, Iran. 1Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran 2. 2Infectious diseases research center, Kashan university of medical sciences, Kashan, Iran 3. 2Infectious diseases research center, Kashan university of medical sciences, Kashan, Iran 4. ۴Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran 5. 5Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
Introduction: Background
Meningitis which refer to inflammation of leptomeningeal space is a dangerous condition. According to its etiological factor categorized into septic and aseptic meningitis. Septic meningitis need early therapeutic intervention thus differentiation of the type of meningitis could prevent neurological sequelae. Due to the delay in reporting the results of cerebrospinal fluid cultures, which are the gold standard diagnostic method, the use of rapid laboratory diagnostic tests will be handy.
Objective
This study was conducted to determine the diagnostic value of CRP, cortisol and procalcitonin (PCT) of cerebrospinal fluid (CSF) in differentiating the types of meningitis.
Methods: Methods
This is a cross-sectional analytic study implanted in Shahid Beheshti hospital of Kashan city from Jan. 2023 to Jul. 2024. After obtaining the approval of the ethics committee (IR.KAUMS.MEDNT.REC.1402.100); all patients` CSF samples who were taken with suspicion of meningitis collected from laboratory center. CSF pattern analyzed and samples with pleocytosis more than 5 cells/mm3 included in study. Patients with immune deficiency or autoimmune diseases, adrenal insufficiency, hypothalamic–pituitary axis disorders, cirrhosis, thyroidectomy and previous antibiotic and corticosteroid therapy excluded. After determining demographic information of patients, CSF samples analysis were carried out to determine CRP, cortisol and PCT level. By evaluating of CSF pattern along the clinical diagnosis, sensitivity and specificity of PCT, cortisol, and CRP of CSF tests in differentiating types of meningitis obtained. The receiver-operating characteristic (ROC) curve was used for determination of the cut off levels using SPSS software and other statistical tests was done.
Results: Results
Out of 68 participants in this study, 41 (60.29%) cases were male and 27 (39.7%) were female.
34 cases were diagnosed as septic and aseptic meningitis equally. Mean of age in septic meningitis was 44.59 years and 37.06 in aseptic group.
Cut off level of PCT was 0.38 ng/mL with sensitivity and specificity of 93.9% and 41.2% respectively in this point.
Cut off levels for cortisol was obtained 0.99 µg/dL in the ROC curve. Sensitivity and specificity of cortisol was 81.8% and 32.4% respectively.
Sensitivity of CRP was 64.7% with specificity of 32.4% in cut off level of 2.5 mg/L in the ROC curve.
Conclusion: Conclusion
CSF-PCT, cortisol and CRP has suitable diagnostic value in distinguishing between bacterial from aseptic meningitis especially in cases of negative bacterial culture of the blood and spinal fluid. Because the results of this research are in agreement with previous studies thus we recommend their usage in the clinical setting.