Diagnostic Accuracy of Cerebrospinal Fluid Procalcitonin for Meningitis in Infants

Strategic Insights -

Researchers have identified the limitations of cerebrospinal fluid (CSF) markers in diagnosing meningitis in infants. The study found that CSF procalcitonin has moderate sensitivity and specificity for diagnosing meningitis in infants with a postnatal age of less than 90 days. However, the results are hindered by wide confidence intervals and very low certainty of evidence.

Key Takeaways:

  • The study searched databases from inception to March 15, 2025, and included observational studies that used CSF procalcitonin as a marker for diagnosing meningitis in infants with a postnatal age of less than 90 days.
  • Seven studies involving 963 infants were included in the meta-analysis, which assessed the diagnostic accuracy of CSF procalcitonin at commonly used threshold cut-offs of 0.20 ng/mL and 0.33 ng/mL.
  • At a CSF procalcitonin threshold cut-off of 0.20 ng/mL, the pooled sensitivity was 77.1% (49.2%, 92.1%), and the pooled specificity was 68.9% (49.2%, 83.5%).
  • At a cut-off of 0.33 ng/mL, sensitivity was 75.8% (50.1%, 90.7%) and specificity was 75.1% (58.5%, 86.6%).
  • The certainty of evidence remained very low for both sensitivity and specificity due to wide confidence intervals and very low certainty of evidence.
  • The study was conducted by researchers at the Institute of Medical Sciences and SUM Hospital, led by Vijay Kumar Krishnegowda, and published in the Indian Pediatrics journal.

Statistics:

  • 815 retrieved records were analyzed in the study
  • 7 studies involving 963 infants were included in the meta-analysis
  • Pooled sensitivity was 77.1% (49.2%, 92.1%) at a CSF procalcitonin threshold cut-off of 0.20 ng/mL
  • Pooled specificity was 68.9% (49.2%, 83.5%) at a CSF procalcitonin threshold cut-off of 0.20 ng/mL
  • Sensitivity was 75.8% (50.1%, 90.7%) at a cut-off of 0.33 ng/mL
  • Specificity was 75.1% (58.5%, 86.6%) at a cut-off of 0.33 ng/mL

Sources:

  • Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Indian Pediatrics, Springer India, 7TH Floor, Vijaya Building, 17, Barakhamba Road, New Delhi, 110 001, India
  • Vijay Kumar Krishnegowda, Dept. of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Prathik Bandiya, Debasish Nanda, and Anup Thakur, co-authors of the study