Study of different diagnostic markers used to differentiate septic from aseptic meningitis

AimThe aim of this study was to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in comparison to procalcitonin (PCT) and C-reactive protein (CRP) in early diagnosis of septic meningitis and its usefulness to distinguish between septic and aseptic meningitis.Patients and methodsThis study included 26 patients with septic meningitis, 32 patients with aseptic meningitis and 15 controls. Besides Gram staining, cultures of blood and CSF and latex agglutination test of CSF, CRP, serum PCT and sTREM-1 measurement were done on admission and after 48–72 h of treatment.ResultsSeptic meningitis was diagnosed in 26 (44.82%) of the studied cases. Patients with septic meningitis had a significant increase in serum sTREM-1 and PCT levels at the time of admission (mean 32.99 ± 19.7 ng/ml and 97.9 ± 86.35 ng/ml, respectively), while patients with aseptic meningitis showed (6.8 ± 5.67 ng/ml and 1.88 ± 1.6 ng/ml, respectively). Control group showed sTREM-1 and PCT levels (6.6 ± 4.6 ng/ml and 0.58 ± 0.36 ng/ml, respectively) (P < 0.05). sTREM-1 demonstrated significantly higher sensitivity (93.7%) and specificity (94.3%) in the early prediction of sepsis with an area under the receiver operator characteristic (ROC) curve (95% CI) of 0.94 (0.84–0.99) at a cut off value of 12.4 ng/ml. Moreover, sTREM-1 but not PCT or CRP concentration was significantly lower (P < 0.001) at admission in patients with poor outcome than in those with good prognosis.ConclusionsBoth serum PCT and sTREM-1 are valuable in the early distinguishing of septic from aseptic meningitis in children but with markedly higher diagnostic discriminatory power for sTREM-1. Moreover, sTREM-1 has a significant value in determining the prognosis of cases with septic meningitis.