Application Value Of Procalcitonin In Adult Patients With Central Nervous System Infections

Objective: This study aimed to investigate the application value of serum and cerebrospinal fluid procalcitonin in adult patients with central nervous system infections.Methods: 61 adult patients with central nervous system infections hospitalized in the Department of Neurology, Affiliated Hospital of Ningxia Medical University and the Infectious Diseases Hospital of Yinchuan from June 2010 to December 2010 were enrolled in our study. Still, we chose 22 patients without central nervous system infection as a normal group. Among those patients, there were 45 male and 41female.The selected patients were divided into 4 groups, 23 patients with purulent meningitis, 18 patients with tuberculous meningitis, 23 patients with viral encephalitis, and 22 without any infections. Then recorded the main results of blood and CSF test, CSF biochemistry test, CSF cytology, bacterial smear, cultivation of all patients. Meanwhile, blood and cerebrospinal fluid samples were collected for measuring of procalcitonin levels by means of ELISA. All statistical analysis was performed with spss 13.0, P <0.05 was considered statistically significant.Results: 1. Serum and CSF PCT levels were significantly higher in group of purulent meningitis, tuberculous meningitis and viral meningitis than in the group of normal group and the difference was statistically significant. 2. Compared with CSF PCT, serum PCT level was a better indicator to discriminate between purulent meningitis and tuberculous meningitis. If we considered serum cut-off level of 0.81ng/ml, then the sensitivity and specificity will be 95.7% and 94.4%, and area under the curve was 0.97; Also, serum PCT level could be served as a better indicator in discrimination between purulent meningitis and viral meningitis, and the best serum cut-off level was 0.75ng/ml; However, we found in our study that CSF PCT level was a better indicator compared to serum PCT in discrimination between tuberculous meningitis and viral meningitis, and the best serum cut-off levels was 0.27ng/ml. 3. Serum and CSF PCT levels of patients with severe central nervous system infection in every group were elevated compared with those with mild infection and the difference was statistically significant. 4. Spearman correlation showed that CSF PCT level was positively correlated with serum PCT concentration, type of central nervous system infection, degree of infection , cerebrospinal fluid protein content and CSF leucocyte concentration.Conclusion: 1. Serum PCT level was a better indicator to discriminate purulent meningitis from tuberculous meningitis or viral meningitis, while CSF PCT level was more valuable in discrimination between tuberculous meningitis and viral meningitis; 2. Serum or CSF PCT levels could help in evaluating the degree of central nervous system infection.