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EG |
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| Egypt J Pediatr Allergy Immunol |
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2011 |
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9 |
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02 |
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77-86 |
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ESP - 30 |
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Original articles |
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| Soluble Triggering Receptor Expressed on Myeloid Cells-1 as a marker to
differentiate septic from aseptic meningitis in children: comparison with
procalcitonin and C-reactive protein |
| Azza M. Hassan |
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Hamdy Abo Hagar |
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Sherif El Saadany |
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| Background: Differentiating between septic and aseptic meningitis remains
a challenge. Procalcitonin (PCT) was suggested by many researchers as a
sensitive marker for early diagnosis of septic meningitis but with varying
discriminative power. Triggering receptor expressed on myeloid cells-1
(TREM-1), a neutrophil and monocyte receptor, is up-regulated during
infection with potential role during sepsis. Objectives: The aim of this study
was to evaluate the diagnostic accuracy of soluble TREM-1 in comparison
to PCT and C-reactive protein (CRP) in early diagnosis of septic meningitis
and its usefulness to distinguish between septic and aseptic meningitis in
children. Study design: Fifty-one children aged 2 to 162 months identified
as possible cases of meningitis were included in this case control study.
Beside Gram staining, cultures of blood and cerebrospinal fluid (CSF) and
latex agglutination test of CSF, CRP, serum PCT and soluble TREM-1
(sTREM-1) measurement was done on admission, and after 48-72 hours of
treatment. Results: Septic meningitis was diagnosed in 16 (44%) of the
studied cases. Although patients with septic meningitis had a significant
increase in serum sTREM-1 and PCT levels at the time of admission
(median, 25.2 ng/ml and 79.1ng/ml, respectively) in comparison with
patients with aseptic meningitis (4.6 ng/ml and 0.7 ng/ml, respectively) and
control group (4.1 ng/ml and 0.3 ng/ml, respectively) (p <0.0001), sTREM-1
showed 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 cutoff value
of 12.4 ng/ml. Moreover, sTREM-1 but not PCT or CRP concentration was
significantly lower (P=0.007) at admission in patients with poor outcome
than in those with good prognosis. Conclusions: Both serum PCT and
sTREM-1 are valuable in early distinguishing septic from aseptic meningitis
in children but with markedly higher diagnostic discriminatory power for
sTREM-1. Moreover, sTREM-1 has a significant value in predicting the
prognosis of cases with septic meningitis. |
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