Diagnostic Accuracy of Cerebrospinal Fluid Presepsin as a Marker of Bacterial Meningitis in Patients with External Ventricular Drainage – A Cross-Sectional Study in a Tertiary Intensive Care Unit

Abstract

Background: External ventricular drainage (EVD)-related meningitis is one of the most dreaded nosocomial infections, causing severe neurological sequelae leading to high morbidity and mortality. Blood-contaminated cerebra spinal fluid (CSF) hinders prompt diagnosis and, thus, treatment of such infections. In this study, we aim to establish the usefulness of CSF presepsin as a marker of nosocomial bacterial meningitis in suspected patients with EVD against other CSF markers. Methodology: We conducted a cross-sectional study by enrolling all neurosurgical patients with EVD during a 10-month study period. Patients were divided into two groups: the test arm of already-diagnosed bacterial meningitis cases versus the control arm of aseptic meningitis cases. Presepsin in CSF was measured along with other CSF markers such as total leukocyte count, percentage of neutrophils and lymphocytes, glucose, protein, multiplex and polymerase chain reaction test, and cultures were analyzed for both the groups. Results: A total of 33 adult patients with EVD were analyzed during the study period: 18 cases were in the test arm group, and 15 were in the control arm group. Compared with all the measured parameters, CSF presepsin, with a cutoff value of 300 pg/ml, was the only marker that could differentiate between the groups with a diagnostic accuracy of 0.817, with a sensitivity of 84.2%, and a specificity of 82.1%. Conclusion: Presepsin in CSF is a reliable diagnostic marker of bacterial meningitis in suspected patients with EVD.