Kocaeli Med J. 2024; 13(1): 56-64 | DOI: 10.5505/ktd.2024.22804

Comparative Diagnostic Value of Procalcitonin, C-Reactive Protein, and Lactate Measurements in Cerebrospinal Fluid for the Diagnosis of Central Nervous System Infections

Ilkay Akbulut¹, þükran köse², ilker Ödemiþ¹, Baþak Göl Serin^3
1Department Of Infectious Diseases And Clinical Microbiology, Health Sciences University Tepecik Research And Training Hospital, Izmir, Türkiye
²Department Of Infectious Diseases And Clinical Microbiology, Dokuz Eylül University, Izmir, Türkiye
³Department Of Infectious Diseases And Clinical Microbiology, Balýkesir Atatürk Training And Research Hospital, Balýkesir, Türkiye

INTRODUCTION: To evaluate the diagnostic value of procalcitonin, C-reactive protein (CRP), and lactate measurements in cerebrospinal fluid (CSF) for the identification of meningitis and the differential diagnosis of bacterial and viral meningitis.


METHODS: Patients who underwent CSF sampling between January 2015 and September 2018 at our hospital in Izmir were included in this study. This prospective study included two patient groups: those with meningitis and controls, and patients with meningitis were further subdivided into viral and bacteriological etiology subgroups. Biochemistry, cell count, Gram staining, molecular viral panel, bacterial cultures, CRP, and procalcitonin were examined in the CSF. P-value of <0.05 was considered statistically significant.

RESULTS: In this study, 96 patients (47 cases and 49 controls) were included. Meningitis of viral and bacterial etiology was diagnosed in 12 (25.6%) and 35 (74.4%) patients, respectively. High CSF procalcitonin levels were highly discriminatory between controls and all meningitis patients, as well as between meningitis subgroups, with high sensitivity and specificity for the cut-off values. CSF CRP and lactate were also able to provide cut-off values for the differential diagnosis of meningitis subgroups. However, their sensitivity and specificity were not as high as those of procalcitonin.

DISCUSSION AND CONCLUSION: Procalcitonin and CRP measured in CSF may represent valuable biomarkers, particularly for diagnosing bacterial meningitis, although these biomarkers should be used in conjunction with other parameters for differential diagnosis.

Keywords: cerebrospinal fluid, biomarkers, C-reactive protein, lactate, procalcitonin, meningitis

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Beyin Omurilik Sývýsýnda Prokalsitonin, C-Reaktif Protein ve Laktat Biyobelirteçlerinin Santral Sinir Sistemi Enfeksiyonu Tanýsýndaki Karþýlaþtýrýlmalý Yeri

Ilkay Akbulut¹, þükran köse², ilker Ödemiþ¹, Baþak Göl Serin^3
1Saðlýk Bilimleri Üniversitesi Tepecik Eðitim Ve Araþtýrma Hastanesi, Enfeksiyon Hastalýklarý Ve Klinik Mikrobiyoloji Kliniði, Izmir, Türkiye
²Dokuz Eylül Üniversitesi, Enfeksiyon Hastalýklarý Ve Klinik Mikrobiyoloji Anabilim Dalý, Izmir, Türkiye
³Balýkesir Atatürk Eðitim Ve Araþtýrma Hastanesi, Enfeksiyon Hastalýklarý Ve Klinik Mikrobiyoloji Kliniði, Balýkesir, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmada menenjit tanýsýnda ve bakteriyel/viral menenjit ayýrýcý tanýsýnda beyin omurilik sývýsý (BOS) prokalsitonini, C-reaktif proteini (CRP) ve laktat seviyesinin tanýsal deðerinin araþtýrýlmasý ve karþýlaþtýrýlmasý amaçlanmýþtýr.

YÖNTEM ve GEREÇLER: Saðlýk Bilimleri Üniversitesi Ýzmir Tepecik Eðitim ve Araþtýrma Hastanesinde 2015 Ocak – 2018 Eylül tarihleri arasýnda BOS örneði alýnan hastalar dahil edilmiþtir. Çalýþma prospektif planlanmýþ olup hastalar önce menenjit ve kontrol grubu olarak iki gruba, menenjit hastalarý da viral ve bakteriyel olarak iki alt gruba ayrýldý. BOS biyokimya deðerleri, hücre sayýmý, gram boyamasý, viral moleküler panel ve bakteriyel kültürü, BOS CRP ve BOS prokalsitonin bakýldý ve p deðeri <0,05 ise istatistiksel olarak anlamlý kabul edildi.

BULGULAR: Çalýþmaya 47’si hasta 49’u kontrol grubu olmak üzere toplam 96 kiþi dahil edildi. Hasta grubunun 12’si (25.6%) viral menenjit, 35’i (74.4%) bakteriyel menenjitti. BOS prokalsitonin deðerinin yüksekliðinin hem kontrol ile menenjit grubu arasýnda hem de menenjit grubunun alt grup ayýrýcý tanýsýnda anlamlý farklýlýkta olduðu, yüksek duyarlýlýk ve özgüllükte eþik deðeri saptadýk. Ayrýca BOS CRP ve laktat deðerleri için menenjit alt grup ayýrýcý tanýsýnda kesim deðeri oluþturulabileceði fakat prokalsitonin kadar yüksek duyarlýlýk ve özgüllükte olmadýðý sonucuna ulaþýldý.

TARTIÞMA ve SONUÇ: Beyin omurilik sývýsýndaki prokalsitonin ve CRP’nin özellikle bakteriyel menenjit tanýsýnda yararlý bir belirteç olabileceðini saptandý, ancak ayýrýcý tanýda biyobelirteçlerin diðer parametrelerle birlikte kullanýlmasý gerekmektedir.

Anahtar Kelimeler: beyin omurilik sývýsý, biyobelirteç, c-reaktif protein, laktat, prokalsitonin, menenjit

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