Clinical value of determining heparin-binding protein of cerebrospinal fluid in children with purulent meningitis

Objective To explore the clinical value of determining heparin-binding protein(HBP) of cerebrospinal fluid(CSF) in the diagnosis and prognostic prediction in children with purulent meningitis(PM). Methods 76 children with PM, 55 children with viral encephalitis(VE) and 40 control children with non-infectious diseases, all admitted to Hunan Children′ Hospital from August 2018 to January 2019, were enrolled in this retrospective study. Children with PM were divided into favorable prognosis group and poor prognosis group according to the Glasgow Outcome Scale on discharge. CSF HBP, white blood cell count(WBC), percentage of neutrophilic granulocyte(N%), glucose(Glu), total protein(TP), lactic dehydrogenase (LDH) and serum procalcitonin(PCT) were analyzed on the first day of admission(DAY1) in PM group, VE group and control group, and on the seventh day of admission(DAY7) in PM group. Nonparametric tests were used to detect the differences of the laboratory indexes and Spearman rank correlation test was utilized to analyze the correlation between HBP and other markers. Receiver operating characteristic curves (ROC curves) were established to evaluate the values of the detection indexes in the diagnosis and prognosis of PM. Results The differences of CSF HBP[63.09(18.10-272.19)ng/mL, 5.90(5.90-6.40)ng/mL and 5.90(5.90-5.90)ng/mL], WBC[365.00(20.00-1285.00)×106/L, 21.00(8.00-30.00)×106/L and 13.50(7.25-21.00)×106/L], N%[0.65(0.50-0.79), 0.19(0.10-0.25) and 0.21(0.15-0.27)], Glu[1.97(1.07-3.08)mmol/L, 2.89(2.66-3.42)mmol/L and 3.04(2.68-3.42)mmol/L], TP[1.43(0.63-1.88)g/L, 0.23(0.16-0.32)g/L and 0.13(0.10-0.31)g/L], LDH[152.00(46.50-461.50)IU/L, 16.00(13.20-22.00)IU/L and 16.00(10.25-19.75) IU/L] and serum PCT[1.35(0.19-9.33)ng/mL, 0.06(0.03-0.11)ng/mL and 0.08(0.05-0.14)ng/mL] levels on DAY1 were statistically significant among PM group, VE group and control group(HHBP=138.62, HWBC=69.72, HN%=106.67, HGlu=34.08, HTP=68.00, HLDH=85.11, HPCT=79.20, P 0.05). But the indexes on DAY7 for predicting poor prognosis were significant (P<0.05) and HBP still had the largest AUC (0.976) for predicting the poor prognosis with good sensitivity, specificity, positive predictive value, negative predictive value (100.0%, 93.8%, 76.3%, 100.0%, respectively) at the optimal cut-off value(128.84 ng/mL). CSF HBP was positively correlated to CSF WBC, N%, TP, LDH, serum PCT level(rWBC=0.670, rN%=0.802, rTP=0.562, rLDH=0.524, rPCT=0.436, P<0.001) and negatively correlated to CSF Glu level(r=-0.469, P<0.001). Conclusions CSF HBP is valuable in the diagnosis and prognostic prediction in children with purulent meningitis. Key words: Heparin-binding protein; Antimicrobial cationic peptides; Purulent meningitis; Cerebrospinal fluid; Child