Diagnostic Value of Serum Procalcitonin, CSF Neutrophil-to-lymphocyte Ratio, and CSF Lactate in Pediatric Bacterial Meningoencephalitis.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Annals of Indian Academy of Neurology Pub Date : 2024-07-01 Epub Date: 2024-08-16 DOI:10.4103/aian.aian_384_24

Andika Priamas Nugrahanto, Agung Triono, Rais Aliffandy Damroni, Elisabeth Siti Herini

{"title":"Diagnostic Value of Serum Procalcitonin, CSF Neutrophil-to-lymphocyte Ratio, and CSF Lactate in Pediatric Bacterial Meningoencephalitis.","authors":"Andika Priamas Nugrahanto, Agung Triono, Rais Aliffandy Damroni, Elisabeth Siti Herini","doi":"10.4103/aian.aian_384_24","DOIUrl":null,"url":null,"abstract":"Background: Bacterial meningoencephalitis presents significant diagnostic and therapeutic challenges with high morbidity and mortality in pediatric populations worldwide. The early and precise identification of the etiology of these infections is essential for effective treatment and better patient results. Traditional diagnostic methods, while effective, can be time-consuming. This manuscript aims to evaluate the accuracy of serum procalcitonin (PCT), cerebrospinal fluid (CSF) neutrophil-to-lymphocyte ratio (NLR), and CSF lactate as biomarkers in pediatric bacterial meningoencephalitis.Methods: From March 2021 to November 2023, a cross-sectional study was conducted at Dr. Sardjito General Hospital, a tertiary referral hospital in Yogyakarta, Indonesia. One hundred ninety-seven patients underwent complete clinical and laboratory examinations before being divided into bacterial and non-bacterial groups based on CSF culture results and cytochemical profiles. The diagnostic accuracy was evaluated by the receiver operating characteristic curve using Statistical Package for the Social Sciences.Results: Serum PCT, CSF NLR, and CSF lactate levels showed a notable increase in the bacterial meningoencephalitis group (mean = 4.63 ± 5.52 ng/ml, 4.39 ± 6.68, and 3.59 ± 2.38 mmol/l, respectively) compared to the viral/aseptic group (mean = 0.51 ± 0.88 ng/ml, 0.33 ± 0.95, and 2.25 ± 2.33 mmol/l, respectively) ( P < 0.001). Serum PCT and CSF NLR combined measurement had high sensitivity (86.4%) and specificity (88.6%), with an area under the curve of 0.929 (95% confidence interval, 0.873-0.985), surpassing other tested biomarkers.Conclusion: The findings suggest that combining serum PCT and CSF NLR could be beneficial for early diagnosis, potentially allowing timely, targeted treatment and differentiating between bacterial and non-bacterial infections, ultimately improving patient outcomes.","PeriodicalId":8036,"journal":{"name":"Annals of Indian Academy of Neurology","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418776/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Indian Academy of Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/aian.aian_384_24","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/16 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Bacterial meningoencephalitis presents significant diagnostic and therapeutic challenges with high morbidity and mortality in pediatric populations worldwide. The early and precise identification of the etiology of these infections is essential for effective treatment and better patient results. Traditional diagnostic methods, while effective, can be time-consuming. This manuscript aims to evaluate the accuracy of serum procalcitonin (PCT), cerebrospinal fluid (CSF) neutrophil-to-lymphocyte ratio (NLR), and CSF lactate as biomarkers in pediatric bacterial meningoencephalitis.

Methods: From March 2021 to November 2023, a cross-sectional study was conducted at Dr. Sardjito General Hospital, a tertiary referral hospital in Yogyakarta, Indonesia. One hundred ninety-seven patients underwent complete clinical and laboratory examinations before being divided into bacterial and non-bacterial groups based on CSF culture results and cytochemical profiles. The diagnostic accuracy was evaluated by the receiver operating characteristic curve using Statistical Package for the Social Sciences.

Results: Serum PCT, CSF NLR, and CSF lactate levels showed a notable increase in the bacterial meningoencephalitis group (mean = 4.63 ± 5.52 ng/ml, 4.39 ± 6.68, and 3.59 ± 2.38 mmol/l, respectively) compared to the viral/aseptic group (mean = 0.51 ± 0.88 ng/ml, 0.33 ± 0.95, and 2.25 ± 2.33 mmol/l, respectively) ( P < 0.001). Serum PCT and CSF NLR combined measurement had high sensitivity (86.4%) and specificity (88.6%), with an area under the curve of 0.929 (95% confidence interval, 0.873-0.985), surpassing other tested biomarkers.

Conclusion: The findings suggest that combining serum PCT and CSF NLR could be beneficial for early diagnosis, potentially allowing timely, targeted treatment and differentiating between bacterial and non-bacterial infections, ultimately improving patient outcomes.

查看原文本刊更多论文

小儿细菌性脑膜脑炎中血清降钙素原、脑脊液中性粒细胞与淋巴细胞比率和脑脊液乳酸盐的诊断价值

背景：细菌性脑膜脑炎给诊断和治疗带来了巨大挑战，在全球儿科人群中具有很高的发病率和死亡率。及早、准确地确定这些感染的病因对于有效治疗和改善患者疗效至关重要。传统的诊断方法虽然有效，但耗时较长。本稿件旨在评估血清降钙素原（PCT）、脑脊液（CSF）中性粒细胞与淋巴细胞比值（NLR）和脑脊液乳酸盐作为小儿细菌性脑膜脑炎生物标志物的准确性：2021年3月至2023年11月，印度尼西亚日惹的一家三级转诊医院--萨吉托博士综合医院开展了一项横断面研究。197名患者接受了完整的临床和实验室检查，然后根据脑脊液培养结果和细胞化学图谱分为细菌组和非细菌组。诊断准确性通过使用社会科学统计软件包（Statistical Package for the Social Sciences）的接收者操作特征曲线（receiver operating characteristic curve）进行评估：细菌性脑膜脑炎组（平均值分别为 4.63 ± 5.52 ng/ml、4.39 ± 6.68 和 3.59 ± 2.38 mmol/l）的血清 PCT、CSF NLR 和 CSF 乳酸水平与病毒性/化脓性脑膜脑炎组（平均值分别为 0.51 ± 0.88 ng/ml、0.33 ± 0.95 和 2.25 ± 2.33 mmol/l）相比明显升高（P < 0.001）。血清 PCT 和 CSF NLR 联合测量的灵敏度（86.4%）和特异性（88.6%）都很高，曲线下面积为 0.929（95% 置信区间，0.873-0.985），超过了其他测试的生物标志物：研究结果表明，将血清 PCT 和脑脊液 NLR 结合起来可用于早期诊断，及时进行有针对性的治疗，并区分细菌感染和非细菌感染，最终改善患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of Indian Academy of Neurology Nervous System Diseases-

CiteScore

2.20

自引率

11.80%

发文量

293

审稿时长

29 weeks

期刊介绍： The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.