Usefulness of Various Biomarkers for the Differentiation of Bacterial from Viral Meningitis

Abstract

Background and Aim: Meningitis is an emergency condition, particularly bacterial meningitis for young and elderly patients. Differentiation between septic and aseptic meningitis may be difficult, the search for biochemical markers and laboratory tests to help in this task is crucial in order to optimize the treatment and avoid unnecessary use of antibiotics especially in aseptic meningitis. The aim of this study was to evaluate the diagnostic and prognostic utility of sTREM-1, CRP, IL-8 in septic meningitis and their usefulness in early differentiation between septic and aseptic meningitis in Egyptian patients. Patients and Methods: This work included 70 patients (25 had septic meningitis group I, 30 had aseptic meningitis group II and 15 control individual group III). sTREM-1, IL-8 and CRP measurements were done on admission and after 48-72 h of treatment, in addition to Gram stain, culture of blood and CSF, latex agglutination test of CSF. Results: Bacterial (septic) meningitis was found in 25 (35.7%) of the studied groups. Patients with septic meningitis had a significant increase in serum sTREM-1 and IL-8 and CRP at the time of admission (32.99±19.79, 2.46±1.8 and 126±90.5 respectively) while patients with aseptic meningitis had (6.8±5.67, 0.66±0.118 and 35±25.38 respectively), the control group had (6.6±4.6, 0.055±0.07 and 15{C}{C}±4 respectively) (P<0.05). sTREM-1 showed significant 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 88.2 (84-93) at a cut off value of 12.4 ng/ml. Moreover, sTREM-1 level was significantly low (P<0.001) at admission in 6 patients out of 25 patients who had septic meningitis who showed poor outcome. Conclusion: sTREM-1 and IL-8 are valuable in early distinguishing of septic from aseptic meningitis but with higher diagnostic discriminatory power for sTREM-1 in determining septic meningitis prognosis and this marker would facilitate the clinical decision of interrupting antimicrobial therapy and avoiding unnecessary hospitalization.