Diagnostic value of procalcitonin and lactate in cerebrospinal fluid combined with conventional biomarkers for post-neurosurgical bacterial meningitis / 中华临床感染病杂志

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.