Heparin-binding protein: A diagnostic marker of acute bacterial meningitis. a diagnostic marker of acute bacterial meningitis

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The early detection of bacterial meningitis is crucial for successful outcome. Heparin-binding protein, a potent inducer of increased vascular permeability, is released from activated neutrophils in severe sepsis.

OBJECTIVE: In this study we investigated whether heparin-binding protein levels in cerebrospinal fluid could be used as a diagnostic marker for acute bacterial meningitis.

DESIGN: One prospective and one retrospective patient cohort from two university hospitals in Sweden were analyzed.

SETTING AND PATIENTS: Cerebrospinal fluid samples were collected from 174 patients with suspected central nervous system infection. Thirty-seven patients with acute community-acquired bacterial meningitis, four patients with neurosurgical bacterial meningitis, 29 patients with viral meningitis or encephalitis, seven patients with neuroborreliosis, and 97 control patients were included.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Cerebrospinal fluid samples were analyzed for the concentrations of heparin-binding protein, lactate, protein, glucose, neutrophils, and mononuclear cells. Heparin-binding protein levels were significantly higher (p < .01) in patients with acute bacterial meningitis (median 376 ng/mL, range 12-858 ng/mL) than in patients with viral central nervous system infection (median 4.7 ng/mL, range 3.0-41 ng/mL) or neuroborreliosis (median 3.6 ng/mL, range 3.2-10 ng/mL) or in control patients with a normal cerebrospinal fluid cell count (median 3.5 ng/mL, range 2.4-8.7 ng/mL). In the prospectively studied group, a heparin-binding protein concentration exceeding 20 ng/mL gave a sensitivity of 100%, a specificity of 99.2%, and positive and negative predictive values of 96.2% and 100%, respectively, in diagnosing acute bacterial meningitis. The area under the receiver-operating characteristic curve for heparin-binding protein was 0.994, which was higher than for the other investigated parameters.

CONCLUSION: Elevated cerebrospinal fluid levels of heparin-binding protein distinguish between patients with acute bacterial meningitis and patients with other central nervous system infections.

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Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Anesthesiology and Intensive Care

Keywords

  • Adolescent, Adult, Aged, Aged, 80 and over, Antimicrobial Cationic Peptides, Biomarkers, Blood Proteins, Carrier Proteins, Encephalitis, Viral, Female, Humans, Leukocyte Count, Male, Meningitis, Bacterial, Meningitis, Viral, Middle Aged, Prospective Studies, ROC Curve, Retrospective Studies, Statistics, Nonparametric, Young Adult, Journal Article, Research Support, Non-U.S. Gov't
Original languageEnglish
Pages (from-to)812-817
Number of pages6
JournalCritical Care Medicine
Volume39
Issue number4
Publication statusPublished - 2011 Apr
Publication categoryResearch
Peer-reviewedYes

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