Capacidad de la procalcitonina para predecir meningitis bacterianas en el servicio de urgencias
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Introduction The aim of this study was to analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis and predicting bacteraemia.Methods Prospective, observational, and descriptive analytical study of 98 consecutive patients aged ≥15 years and diagnosed with acute meningitis in an emergency department between August 2009 and July 2013.Results We analysed 98 patients with AM (66 males [67%]); mean age was 44±21 years. The diagnosis was bacterial meningitis in 38 patients (20 with bacteraemia); viral meningitis in 33; probable viral meningitis in 15; and presumptively diagnosed partially treated acute meningitis in 12. PCT had the highest area under the ROC curve (AUC) (0.996; 95% CI, 0.987-1; p<0.001). With a cutoff of ≥ 0.74 ng/ml, PCT achieved 94.7% sensitivity, 100% specificity, negative predictive value (NPV) of 93.9%, and positive predictive value (PPV) of 100%. The mean levels for PCT were11.47±7.76 ng/ml in bacterial meningitis vs. 0.10±0.15 ng/ml in viral meningitis (p <0.001). The AUC for CRP was 0.916 and a cutoff of ≥ 90 mg/L achieved 67.5% sensitivity, 86.3% specificity, PPV of 89.2%, and NPV of 90.4%. As a predictor of bacteraemia in bacterial meningitis, only PCT delivered a significant difference (14.7±7.1 ng/mL vs. 4.68±3.54 ng/mL, p<0.001). A cutoff of ≥ 1.1 ng/mL achieved 94.6% sensitivity, 72.4% specificity, NPV of 95.4%, and PPV of 69.2%; the AUC was 0.965 (95% CI, 0.921-1; p<0.001).Conclusions PCT has a high diagnostic power for acute meningitis in emergency department patients. PCT outperforms CRP in the detection of bacterial aetiology and is a good predictor of bacteraemia in bacterial meningitis.
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Serum procalcitonin measurement has been reported to have a sensitivity of ∼95% and a specificity of ∼100% in distinguishing bacterial from viral meningitis in adults.
“The use of serum procalcitonin measurement remains limited due to cost but where available has been reported to have a sensitivity of ∼95% and a specificity of ∼100% in distinguishing bacterial from viral meningitis in adults.45”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [45]
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- Authors
- Morales Casado, M. I., Moreno Alonso, F., Juárez Belaunde, A. L., Heredero Gálvez, E., Talavera Encinas, O., & Julián-Jiménez, A.
- Affiliations
- Hospital Virgen de la Salud (ES)
- Corresponding author
- Julián-Jiménez, A.
- ORCID
- Julián-Jiménez, A.
- Venue
- Neurología
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 31
- Issue
- 1
- Pages
- 9-17
- ISSN
- 0213-4853 (ISSN-L)
- OpenAlex
- W1979070476
- Cited by
- 31
- References
- 30
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 1 · 2022: 2 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 5 · 2015: 5
- FWCI
- 3.53
- Type
- journal article
- Language
- es
- Open access
- bronze
- doi.org
- Licence
- Locations
- Neurología (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- bacterial meningitis, procalcitonin, C-reactive protein, bacteremia, acute meningitis, viral meningitis, diagnostic accuracy, emergency department, biomarkers, receiver operating characteristic, sensitivity and specificity, adults, meningococcal meningitis, Haemophilus influenzae type b
- MeSH terms
- Adult, Aged, C-Reactive Protein, Calcitonin, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Meningitis, Bacterial, Young Adult
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