The diagnostic value of the first blood inflammatory indicators and cerebrospinal fluid parameters after admission for bacterial meningitis in children

Objective To explore the diagnostic value of the first blood inflammatory indicators and cerebrospinal fluid (CSF) parameters after admission for bacterial meningitis (BM) in children.

Methods A total of 105 children with BM were selected as the research subjects, and 170 children diagnosed with viral encephalitis or meningitis during the same period were selected as the control group. The blood inflammatory indicators white blood cell count (WBC), neutrophil count (NEUT), percentage of neutrophils (NEUT%), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width -CV to platelet ratio, red blood cell distribution width -SD to platelet ratio, serum drop Procalcitonin (PCT) and C-reactive protein (CRP) within 24 hours of admission, CSF parameters CSF-WBC, CSF lactic acid (CSF-LA), CSF protein (CSF-Pro), CSF glucose (CSF-Glu) and CSF chloride (CSF-CL), and results of CSF bacterial culture, cerebrospinal fluid metagenomic next-generation sequencing (mNGS) and blood culture in two groups were collected.

Results Among the 105 children with BM, 68 cases (64.76%) were diagnosed clinically, and 38 cases (36.19%) were diagnosed etiologically. Among them, 25 cases (23.81%) were positive for CSF culture, 2 cases were positive for CSF Gram staining, and 12 cases were positive for CSF mNGS (a total of 15 cases were sent for examination, among which 1 case was positive for both CSF mNGS and CSF culture). The differences of WBC, NEUT, NEUT%, NLR, PCT, CRP, CSF-WBC, CSF-LA, CSF-GLU, CSF-CL and CSF-PRO were statistically significant between the BM group and control group (P ＜ 0.05 to P ＜ 0.01). The results of multivariate logistic regression analysis showed that the WBC, CSF-LA and CSF-PRO were the independent influencing factors of BM (P ＜ 0.05 to P ＜ 0.01). The results of ROC curve analysis showed that the AUCs of WBC, CSF-LA, and CSF-PRO in diagnosing childhood BM were 0.670, 0.982, and 0.964, respectively. The AUC of the combined diagnosis of the three for childhood BM was 0.991, which was superior to that of WBC, CSF-LA, and CSF-PRO.

Conclusions The WBC, CSF-LA, and CSF-PRO can be used as the diagnostic predictors of BM in children. The combined index of WBC + CSF-LA + CSF-PRO can improve the diagnostic and predictive efficacy of BM, and the CSF mNGS can increase the pathogen detection rate of BM in children.