Predictive value of decoy receptor 3 in postoperative nosocomial bacterial meningitis.

Yong-Juan Liu,Jian Zhang,Li-Hua Shao,Hai-Hong Liu,Xiao-Meng Dong,Qian Wang,Rui-Ping Ma,Li-Xian Ma

doi:10.3390/ijms151119962

Abstract

Nosocomial bacterial meningitis requires timely treatment, but what is difficult is the prompt and accurate diagnosis of this disease. The aim of this study was to assess the potential role of decoy receptor 3 (DcR3) levels in the differentiation of bacterial meningitis from non-bacterial meningitis. A total of 123 patients were recruited in this study, among them 80 patients being with bacterial meningitis and 43 patients with non-bacterial meningitis. Bacterial meningitis was confirmed by bacterial culture of cerebrospinal fluid (CSF) culture and enzyme-linked immunosorbent assay (ELISA) was used to detect the level of DcR3 in CSF. CSF levels of DcR3 were statistically significant between patients with bacterial meningitis and those with non-bacterial meningitis (p < 0.001). A total of 48.75% of patients with bacterial meningitis received antibiotic >24 h before CSF sampling, which was much higher than that of non-bacterial meningitis. CSF leucocyte count yielded the highest diagnostic value, with an area under the receiver operating characteristic curve (ROC) of 0.928, followed by DcR3. At a critical value of 0.201 ng/mL for DcR3, the sensitivity and specificity were 78.75% and 81.40% respectively. DcR3 in CSF may be a valuable predictor for differentiating patients with bacterial meningitis from those with non-bacterial meningitis. Further studies are needed for the validation of this study.

Highlights

Nosocomial bacterial meningitis is a life-threatening disease, which is more frequently seen in neurosurgical patients than other patients [1]
One hundred and twenty-three patients were enrolled for the study, among them 80 patients being diagnosed with bacterial meningitis and 43 patients with non-bacterial meningitis
The rate of receiving antibiotic >24 h before cerebrospinal fluid (CSF) sampling in bacterial meningitis was much higher than that of non-bacterial meningitis (p < 0.001)

Summary

Introduction

Nosocomial bacterial meningitis is a life-threatening disease, which is more frequently seen in neurosurgical patients (i.e., patients with placement of internal or external ventricular catheters, complicated head trauma, craniotomy) than other patients (patients with spinal anesthesia, myelography, hospital-acquired bacteremia, and so forth) [1]. The incidence rate of nosocomial meningitis can range from 0.8% to 17% following neurosurgical procedure, while its mortality is up to 34% or even higher [1,2,3]. Accurate diagnosis and appropriate treatment are associated with better outcomes [4,5,6]. Accurate diagnosis of bacterial meningitis is based on microbiological culture which usually takes at least 24–48 h to yield results and may lead to delayed treatment. Delay in treatment is related to adverse clinical outcome. The microbiological culture results may be negative because of the previous use of antibiotics [1]. For this reason, it is important to identify desirable indicators for the rapid diagnosis of bacterial meningitis

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Conclusion