Ability of Procalcitonin and C-Reactive Protein for Discriminating between Bacterial and Enteroviral Meningitis in Children Using Decision Tree

Dmitriy Babenko,Aliya Seidullayeva,Dinagul Bayesheva,Aigul Almabayeva,Samat Kozhakhmetov,Baurzhan Omarkulov,Almagul Kushugulova,Bayan Turdalina,Marina Zhanaliyeva,Alireza Baghban

doi:10.1155/2021/5519436

Abstract

Bacterial meningitis (BM) is a public health burden in developing countries, including Central Asia. This disease is characterized by a high mortality rate and serious neurological complications. Delay with the start of adequate therapy is associated with an increase in mortality for patients with acute bacterial meningitis. Cerebrospinal fluid culture, as a gold standard in bacterial meningitis diagnosis, is time-consuming with modest sensitivity, and this is unsuitable for timely decision-making. It has been shown that bacterial meningitis differentiation from viral meningitis could be done through different parameters such as clinical signs and symptoms, laboratory values, such as PCR, including blood and cerebrospinal fluid (CSF) analysis. In this study, we proposed the method for distinguishing the bacterial form of meningitis from enteroviral one. The method is based on the machine learning process deriving making decision rules. The proposed fast-and-frugal trees (FFTree) decision tree approach showed an ability to determine procalcitonin and C-reactive protein (CRP) with cut-off values for distinguishing between bacterial and enteroviral meningitis (EVM) in children. Such a method demonstrated 100% sensitivity, 96% specificity, and 98% accuracy in the differentiation of all cases of bacterial meningitis in this study. These findings and proposed method may be useful for clinicians to facilitate the decision-making process and optimize the diagnostics of meningitis.

Highlights

Meningitis is a life-threatening inflammatory disease of the brain and spinal cord, mostly caused by bacterial, viral, and fungal infection [1,2,3]
Bacterial meningitis as a more serious form of meningitis is caused by pyogenic bacteria, such as S. pneumoniae, N. meningitidis, and H. influenzae [6]
Children with enteroviral meningitis (EVM), that had a median age of 82.5 [40.0; 124] months old, were older compared with the Bacterial meningitis (BM) group (Table 1)

Summary

Introduction

Meningitis is a life-threatening inflammatory disease of the brain and spinal cord, mostly caused by bacterial, viral, and fungal infection [1,2,3]. Meningococcal infection has been a big threat to the globe and exists as a sporadic, hypersporadic, and epidemic disease. In 2012, an estimated 1.2 million cases of meningococcal infection per year were reported, with ~135,000 deaths worldwide [4]. The average annual incidence of meningococcal infection in Kazakhstan for the last decade is 0.83/100 000 with a peak in 2015 (2.42/100 000) [5]. Viruses are the most common cause of aseptic meningitis, primarily enteroviruses, together with numerous nonviral and noninfectious disorders [7, 8]

Methods

Results

Conclusion