Abstract
Early diagnosis and treatment of bacterial meningitis in children are essential, due to the high mortality and morbidity rates. However, lumbar puncture is often difficult, and cerebrospinal fluid (CSF) culture takes time. This meta-analysis aims to determine the diagnostic accuracy of blood procalcitonin for detecting bacterial meningitis in children. We conducted a systematic search on electronic databases to identify relevant studies. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, and a hierarchical summary receiver operating characteristic curve and area under the curve (AUC) were determined. Eighteen studies with 1462 children were included in the analysis. The pooled sensitivity, specificity, and the DOR of blood procalcitonin for detecting bacterial meningitis were 0.87 (95% confidence interval (CI): 0.78–0.93); 0.85 (95% CI: 0.75–0.91), and 35.85 (95% CI: 10.68–120.28), respectively. The AUC for blood procalcitonin was 0.921. Blood procalcitonin also showed higher diagnostic accuracy for detecting bacterial meningitis than other conventional biomarkers, including serum C-reactive protein and leukocyte count, CSF leukocyte and neutrophil count, and CSF protein and glucose levels. Blood procalcitonin can be a good supplemental biomarker with high diagnostic accuracy in detecting bacterial meningitis in children.
Highlights
Bacterial meningitis is an inflammation of the meninges associated with bacterial invasion [1,2]
Pediatric bacterial meningitis is diagnosed by the presence of clinical symptoms and the examination of cerebrospinal fluid (CSF) obtained by lumbar puncture [3,5]
Our results showed that blood PCT is a highly accurate test for diagnosing pediatric bacterial meningitis
Summary
Bacterial meningitis is an inflammation of the meninges associated with bacterial invasion [1,2]. Introduction of the conjugate Hib vaccine (in 1990) and the heptavalent pneumococcal conjugate vaccine (in 2000), resulted in a decrease in the overall incidence of bacterial meningitis in countries where it has been implemented [3,4]. The mortality rate (up to 34% even if treated with antibiotics) and incidence of long-term sequelae (up to 50%) from bacterial meningitis among those affected have not changed and remain substantial [2,3]; urgent diagnosis and prompt administration of appropriate antibiotics are crucial in patients with suspected bacterial meningitis. Identification of bacteria by culture or bacterial antigen detection (e.g., via a latex agglutination test) in the CSF can confirm a diagnosis. Typical CSF findings including elevated protein content (>100–150 mg/dl), a CSF: blood glucose ratio
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