ABSTRACT
Objective To investigate the diagnostic value of procalcitonin ( PCT) and lactate in cerebrospinal fluid (CSF) combined with conventional biomarkers for post-neurosurgical bacterial meningitis (PBM).Methods Clinical data of 213 patients with post-neurosurgical meningitis admitted in Beijing Tiantan Hospital, Capital Medical University from March 2017 to December 2017 were retrospectively analyzed, including 85 cases of PBM and 128 cases of post-neurosurgical aseptic meningitis ( PAM).The diagnostic value of CSF procalcitonin , lactate and other 12 conventional biomarkers for PBM was analyzed by multivariate logistic regression.A prediction algorithm was generated and its diagnostic value for PBM was assessed with receiver operating characteristic curve (ROC).Results The univariate analysis showed that CSF cell count, CSF leukocyte count , CSF protein concentration , CSF glucose concentration, CSF glucose／blood glucose ratio, CSF PCT and CSF lactate were significantly associated with PBM.Multivariate logistic regression analysis showed that CSF PCT , CSF lactate, CSF protein concentration and CSF glucose ／blood glucose ratio were independent predictive factors for PBM.The predictive algorithm score ＝4.315 ×CSF PCT+0.822×CSF Lactate+0.009×CSF protein concentration -5.480×CSF glucose／blood glucose ratio-3.074.The predictive algorithm has the largest area under the ROC curve ( AUC ＝0.947), and the sensitivity and specificity of the predictive algorithm score were 90.60% and 85.10%, respectively.The positive predictive value , negative predictive value and the accurate rate of the algorithm in diagnosis of PBM were 84.06%, 94.44% and 90.40%, respectively.Conclusion The predictive algorithm based on the combination of CSF PCT and CSF lactate with CSF protein concentration and CSF glucose ／blood glucose ratio has a good diagnostic value for PBM.It can shorten the diagnosis time of PBM and improve the clinical outcomes.
ABSTRACT
Objective To investigate the changes and clinical significance of serum procalcitonin (PCT) level in children with acute phase of Kawasaki disease (KD). Methods The serum PCT levels and their changes before and after the treatment in 120 children with KD at acute phase were retrospectively analyzed. According to the results of ultrasonic echocardiography, all children were divided into coronary artery damage (CAL) group and no coronary artery lesion (NCAL) group. According to the presence of gastrointestinal symptoms, patients were divided into two groups (A: yes and B: no ). According to the presence of abnormal liver function, patients were divided into two groups (C:yes and D:no). PCT levels were compared between groups. Results The serum PCT levels were increased at acute phase in 56 (46.67%) patients before the treatment than those in normal children, which were decreased obviously after treatment (P0.05). There was no significant difference in serum PCT value between CAL group and NCAL group (P>0.05). The serum C-reactive protein level was significantly higher in CAL group than that of NCAL group. There were 35 patients combined with gastrointestinal symptoms in 120 KD patients. There was no significant difference in the rising rate of PCT between patients with gastrointestinal symptoms (62.86%) and patients without gastrointestinal symptoms (40.00%, P0.05). And there was no significant difference in serum PCT value between the two groups (P>0.05). Conclusion PCT can reflect the acute phase of KD patients. The increased PCT level may be related with the emergence of gastrointestinal symptoms, even though it cannot predict CAL and the occurrence of liver damage.