Clinical utility of cerebrospinal fluid vitamin D-binding protein as a novel biomarker for the diagnosis of viral and bacterial CNS infections

Young Jin Kim,Mutbyul Kim,Bo Gyu Kim,Byoung-Kuk Na,Heeyoung Kang,Min-Chul Cho,Youn-Kwan Jung,Hương Giang Lê

doi:10.1186/s12879-021-05924-z

Abstract

BackgroundRapid and accurate diagnosis of central nervous system (CNS) infections is important, and laboratory tests help diagnose CNS infections. Even when the patient has symptoms, laboratory tests often do not reveal any specific findings. The potential of vitamin D-binding protein (VDBP) to be used as a biomarker for viral and bacterial CNS infections was studied.MethodsA total of 302 subjects with suspected CNS infection who underwent lumbar puncture were included. Clinical and laboratory data were collected retrospectively. VDBP levels were measured in the cerebrospinal fluid (CSF) samples. Genotyping for the GC gene encoding VDBP was also performed. VDBP levels were analyzed and compared by CNS infection, pathogen, CSF opening pressure, and GC genotype.ResultsA CNS infection group (n = 90) and a non-CNS infection group (n = 212) were studied. In terms of its receiver operating characteristic, CSF VDBP showed an area under the curve of 0.726 for the diagnosis of CNS infection. CSF VDBP levels were significantly different between the CNS infection and non-infection groups. The CNS infection group with enterovirus showed a statistically lower distribution of CSF VDBP levels than the other virus groups. The group with CSF opening pressure > 25 cmH2O showed higher CSF VDBP levels than the other groups. There was no significant difference in GC gene allele distribution between the CNS infection and non-infection groups.ConclusionsCSF VDBP levels were increased in patients with CNS infection. The CSF VDBP showed potential as a new biomarker for viral and bacterial CNS infections.

Highlights

Rapid and accurate diagnosis of central nervous system (CNS) infections is important, and laboratory tests help diagnose CNS infections
We found that the concentration of cerebrospinal fluid (CSF) vitamin D-binding protein (VDBP) increased significantly in the CNS infection group compared to the non-CNS infection group
Our research team had observed that the CSF VDBP level was significantly increased in patients with meningitis and has reported that CSF VDBP concentration can potentially be considered a new biomarker for the diagnosis of meningitis, in a previous study [19]

Summary

Introduction

Rapid and accurate diagnosis of central nervous system (CNS) infections is important, and laboratory tests help diagnose CNS infections. Due to the high morbidity and mortality of CNS infections, rapid diagnosis aimed at providing prompt and appropriate treatment is a priority [5]. The gold standard for the diagnosis of CNS infections is microbiological culture. This method shows low sensitivity, and the diagnosis may be delayed [6]. In microbiological culture, bacterial growth requires at least 2 days. The most common bacterial and viral pathogens can be detected with high sensitivity by multiplex realtime polymerase chain reaction (PCR), reducing the laboratory turnaround time. The disadvantages of this PCR-based molecular test are that only a limited number of pathogens can be detected in advance, and skilled technicians and expensive molecular test equipment are required

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