The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis

Objective: Clinically, it is often difficult to differentiate between bacterial and viral aetiologies in adults with suspected meningitis. Several studies have demonstrated the potential use of serum procalcitonin (PCT) in making this differentiation. The aim was to pool these studies into a meta-analysis to determine the diagnostic accuracy of PCT. Methods: Major electronic databases were searched for articles studying the use of serum PCT in the differentiation of bacterial and viral meningitis in adult patients. No date or language restrictions were applied. Data analysis was performed using Meta-DiSc 1.4 and MIX 2.0. Results: Nine studies (n = 725 patients) were included in the meta-analysis. Serum PCT was found to be a highly accurate test for diagnosing meningitis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) for PCT were 0.90 (95% confidence interval (CI) 0.84-0.94), 0.98 (95% CI 0.97-0.99), 27.3 (95% CI 8.2-91.1), 0.13 (95% CI 0.07-0.26), and 287.0 (95% CI 58.5-1409.0), respectively. PCT was found to be far superior to C-reactive protein, which had a pooled DOR of only 22.1 (95% CI 12.7-38.3). Conclusions: Serum PCT is a highly accurate diagnostic test that can be used by physicians for rapid differentiation between bacterial and viral causes of meningitis in adults. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.