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Table 3 Studies of biomarkers in the diagnosis of bacterial meningitis (BM) and its distinction from viral meningitis (VM)

From: Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy

Marker Study 1st author, [ref] Study design Number of patients, n Level of evidence End-point Main result
       Absolute risk reduction (RR)
PCT Gendrel D, [42] Single-centre observational study 59 children (18 BM, 41 VM) Very low Comparison of PCT and CRP level in patients with bacterial or viral meningitis A serum PCT level >0.5 μg/L is associated with bacterial meningitis (Se = 94%; Sp = 100%).
       Large overlap for CRP values
PCT/CRP/INF-ϒ Marc E, [43] Single-centre observational study 58 viral Very low Antibiotic initiation and hospital days, based on a serum PCT < 0.5 to not initiate or stop antibiotics. If PCT >0.5, antibiotics stopped if negative cultures and/or INF or PCR (+) in CSF 41 patients did not receive antibiotics; antibiotics stopped in 15/17 pts treated by day 1 or 2, because of a PCT < 0.5.
    (enterovirus outbreak)    
    Children (2 mo – 14 yr)    
       Hospital days reduced to 2 days.
PCT/CRP/sCD 163 Knudsen T, [58] Single-centre observational study (ID department) 55 adult patients suspected of BM Very low Comparison of PCT, CRP and sCD163 levels in patients with bacterial or viral meningitis, or other infection Diagnostic value of CRP (AUC = 0.91) and PCT (AUC = 0.87) superior (p < 0.02 and p < 0.06) to sCD163 (AUC = 0.72);
       sCD163 most specific for systemic bacterial infection (Sp = 0.91).
PCT/CRP Viallon A [61] Single-centre observational study 254 adults (183 VM, 97 BM) Low Predictive value of serum PCT and CRP for the diagnosis of BM AUROC PCT = 0.86; threshold 0.28 μg/mL (Se = 0.97; Sp = 1, VPP = 0.97, VPN = 1)
       AUROC CRP = 0.92; threshold 37 mg/L (Se = 0.86, Sp = 0.84, VPP = 0.46, VPN = 0.97)
CRP Gerdes L, [62] Meta analysis of 10 studies Children and adults low Predictive value of serum CRP for bacterial meningitis Threshold value for CRP varies across studies from 19 to 100 mg/l.
       Se varies from 92% to 94% and NPV is >97%.
Summary table
  Total number of patients Highest level of evidence Directness* Consistency of results** Overall strength of evidence Number of studies
  371 Low Yes Yes Low 3 (PCT)
  1. *Directness: studies provide evidence of a direct association between a treatment or a given risk factor and a judgment criterion.
  2. **Consistency: results from studies of similar level of evidence are not contradictory.