Abstract：
OBJECTIVE: We evaluated the diagnostic accuracy of cerebrospinal fluid (CSF) inflammatory markers for diagnosing bacterial meningitis in neonates with sepsis and/or meningitis.
METHODS: Cases were identified from a prospective multicenter study including patients aged 0-3 months with Group B Streptococcal (GBS) or Escherichia coli culture positive sepsis/meningitis. CSF CXCL10, MDC, IL-6, IL-8, IL-10, TNF- α, MIF, IL-1RA, CXCL13, IL-1β, CRP and procalcitonin concentrations were measured with Luminex technology.
RESULTS: In 61/373 patients (17%) residual CSF from the lumbar puncture was available, of whom 16 (26%) had definitive meningitis, 15 (25%) probable meningitis and 30 (49%) had sepsis. All biomarkers were detectable in CSF and showed significantly higher concentrations in definitive meningitis versus sepsis patients and six biomarkers in probable meningitis versus sepsis patients. Discrimination between definitive meningitis and sepsis was excellent for IL-1RA (area under the receiver operating characteristic curve [AUC] 0.93), TNF-α (AUC 0.92), CXCL10 (AUC 0.90), IL-1β (AUC 0.92), IL-6 (AUC 0.94), IL-10 (AUC 0.93) and a combination of IL-1RA, TNF-α, CXCL-10 and CSF leukocyte count (AUC 0.95). CSF leukocyte count remained the predictor with the highest diagnostic accuracy (AUC 0.96).
CONCLUSIONS: CSF inflammatory markers can be used to differentiate between neonatal sepsis and meningitis.
METHODS: Cases were identified from a prospective multicenter study including patients aged 0-3 months with Group B Streptococcal (GBS) or Escherichia coli culture positive sepsis/meningitis. CSF CXCL10, MDC, IL-6, IL-8, IL-10, TNF- α, MIF, IL-1RA, CXCL13, IL-1β, CRP and procalcitonin concentrations were measured with Luminex technology.
RESULTS: In 61/373 patients (17%) residual CSF from the lumbar puncture was available, of whom 16 (26%) had definitive meningitis, 15 (25%) probable meningitis and 30 (49%) had sepsis. All biomarkers were detectable in CSF and showed significantly higher concentrations in definitive meningitis versus sepsis patients and six biomarkers in probable meningitis versus sepsis patients. Discrimination between definitive meningitis and sepsis was excellent for IL-1RA (area under the receiver operating characteristic curve [AUC] 0.93), TNF-α (AUC 0.92), CXCL10 (AUC 0.90), IL-1β (AUC 0.92), IL-6 (AUC 0.94), IL-10 (AUC 0.93) and a combination of IL-1RA, TNF-α, CXCL-10 and CSF leukocyte count (AUC 0.95). CSF leukocyte count remained the predictor with the highest diagnostic accuracy (AUC 0.96).
CONCLUSIONS: CSF inflammatory markers can be used to differentiate between neonatal sepsis and meningitis.
摘要：
目的：我们评估了脑脊液（CSF）炎症标志物对败血症和/或脑膜炎新生儿细菌性脑膜炎的诊断准确性。
方法：病例来自一项前瞻性多中心研究，包括年龄0-3个月的B组链球菌（GBS）或大肠杆菌培养阳性脓毒症/脑膜炎患者。CSFCXCL-10,MDC,IL6，IL-8，IL-10，TNF-α，MIF,IL-1RA,CXCL13，IL-1β，用Luminex技术测定CRP和降钙素原浓度。
结果：在61/373例患者（17％）中，腰椎穿刺有残留的CSF，其中16人（26%）患有确定性脑膜炎，15（25％）可能的脑膜炎和30（49％）的败血症。所有生物标志物均可在CSF中检测到，并且在确定性脑膜炎与败血症患者中显示出明显更高的浓度，在可能的脑膜炎与败血症患者中显示出六种生物标志物。对于IL-1RA（接受者工作特征曲线下面积[AUC]0.93），确定性脑膜炎和败血症之间的区别非常好。TNF-α（AUC0.92）CXCL-10（AUC0.90），IL-1β（AUC0.92），IL-6（AUC0.94），IL-10（AUC0.93）和IL-1RA的组合，TNF-α,CXCL-10和CSF白细胞计数(AUC0.95)。CSF白细胞计数仍然是具有最高诊断准确性的预测因子（AUC0.96）。
结论：CSF炎症标志物可用于区分新生儿败血症和脑膜炎。
方法：病例来自一项前瞻性多中心研究，包括年龄0-3个月的B组链球菌（GBS）或大肠杆菌培养阳性脓毒症/脑膜炎患者。CSFCXCL-10,MDC,IL6，IL-8，IL-10，TNF-α，MIF,IL-1RA,CXCL13，IL-1β，用Luminex技术测定CRP和降钙素原浓度。
结果：在61/373例患者（17％）中，腰椎穿刺有残留的CSF，其中16人（26%）患有确定性脑膜炎，15（25％）可能的脑膜炎和30（49％）的败血症。所有生物标志物均可在CSF中检测到，并且在确定性脑膜炎与败血症患者中显示出明显更高的浓度，在可能的脑膜炎与败血症患者中显示出六种生物标志物。对于IL-1RA（接受者工作特征曲线下面积[AUC]0.93），确定性脑膜炎和败血症之间的区别非常好。TNF-α（AUC0.92）CXCL-10（AUC0.90），IL-1β（AUC0.92），IL-6（AUC0.94），IL-10（AUC0.93）和IL-1RA的组合，TNF-α,CXCL-10和CSF白细胞计数(AUC0.95)。CSF白细胞计数仍然是具有最高诊断准确性的预测因子（AUC0.96）。
结论：CSF炎症标志物可用于区分新生儿败血症和脑膜炎。
