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Heparin-binding protein: A diagnostic marker of acute bacterial meningitis. : a diagnostic marker of acute bacterial meningitis

Författare:
Publiceringsår: 2011-04
Språk: Engelska
Sidor: 812-817
Publikation/Tidskrift/Serie: Critical Care Medicine
Volym: 39
Nummer: 4
Dokumenttyp: Artikel i tidskrift
Förlag: Lippincott Williams & Wilkins

Sammanfattning

BACKGROUND: The early detection of bacterial meningitis is crucial for successful outcome. Heparin-binding protein, a potent inducer of increased vascular permeability, is released from activated neutrophils in severe sepsis.

OBJECTIVE: In this study we investigated whether heparin-binding protein levels in cerebrospinal fluid could be used as a diagnostic marker for acute bacterial meningitis.

DESIGN: One prospective and one retrospective patient cohort from two university hospitals in Sweden were analyzed.

SETTING AND PATIENTS: Cerebrospinal fluid samples were collected from 174 patients with suspected central nervous system infection. Thirty-seven patients with acute community-acquired bacterial meningitis, four patients with neurosurgical bacterial meningitis, 29 patients with viral meningitis or encephalitis, seven patients with neuroborreliosis, and 97 control patients were included.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Cerebrospinal fluid samples were analyzed for the concentrations of heparin-binding protein, lactate, protein, glucose, neutrophils, and mononuclear cells. Heparin-binding protein levels were significantly higher (p < .01) in patients with acute bacterial meningitis (median 376 ng/mL, range 12-858 ng/mL) than in patients with viral central nervous system infection (median 4.7 ng/mL, range 3.0-41 ng/mL) or neuroborreliosis (median 3.6 ng/mL, range 3.2-10 ng/mL) or in control patients with a normal cerebrospinal fluid cell count (median 3.5 ng/mL, range 2.4-8.7 ng/mL). In the prospectively studied group, a heparin-binding protein concentration exceeding 20 ng/mL gave a sensitivity of 100%, a specificity of 99.2%, and positive and negative predictive values of 96.2% and 100%, respectively, in diagnosing acute bacterial meningitis. The area under the receiver-operating characteristic curve for heparin-binding protein was 0.994, which was higher than for the other investigated parameters.

CONCLUSION: Elevated cerebrospinal fluid levels of heparin-binding protein distinguish between patients with acute bacterial meningitis and patients with other central nervous system infections.

Nyckelord

  • Anesthesiology and Intensive Care
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antimicrobial Cationic Peptides
  • Biomarkers
  • Blood Proteins
  • Carrier Proteins
  • Encephalitis, Viral
  • Female
  • Humans
  • Leukocyte Count
  • Male
  • Meningitis, Bacterial
  • Meningitis, Viral
  • Middle Aged
  • Prospective Studies
  • ROC Curve
  • Retrospective Studies
  • Statistics, Nonparametric
  • Young Adult
  • Journal Article
  • Research Support, Non-U.S. Gov't

Övriga

Published
  • Translational Sepsis research
  • ISSN: 1530-0293

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