Dilshad Ahmad Khan, Aisha Rahman, Farooq Ahmed Khan, Najm.
Comparison of serum procalcitonin and c-reactive protein in diagnosis of bacterial meningitis.
Pak Armed Forces Med J Jan ;59(2):145-6.

Objective: The diagnostic accuracy of Procalcitonin (PCT) as compared with C - reactive protein (CRP) for early diagnosis of bacterial meningitis in children was evaluated. Design: Descriptive diagnostic study. Place on Duration of Study: This study was conducted in Pathology department of Army Medical College Rawalpindi from September 2007 to September 2008. Material and Methods: Descriptive diagnostic accuracy study was conducted in Pathology Department of the Army Medical College , Rawalpindi . Total 77 subjects consisted of 31 patients of bacterial meningitis and 46 healthy children were included as controls from the Military hospital, Rawalpindi . The patients comprised of 18 (58 %) male and 13 (42 %) female with mean age 6 years. Patient’s investigations including cerebrospinal fluid (CSF) examination and culture were carried out at admission. PCT and CRP were analyzed on Vidas analyzer and Immulite 1000 respectively. Results: PCT levels were significantly high median (range) of 4.5 ng/ml (0.10-19.00) ng/ml than controls 0.45 ng/ml (0.10-3.00). Serum CRP levels were moderately elevated with median (range) 11 mg /L (0.30 – 23.00) as compared with 0.30 mg/L (0.30-9.5) controls. The Area under receiver characteristic curve of PCT 0.86 (95 % CI: 0.76-0.93) was significantly higher than CRP 0.72 (95% CI: 0.61-0.82). The optimum diagnostic cutoff point for PCT and CRP were 2 ng/ ml and 6 mg/L respectively by ROC analysis. PCT had maximum sensitivity 74% and specificity 84% at cutoff > 2 ng/ ml while CRP revealed sensitivity 58% and specificity 83% at cutoff > 6mg/ L. Conclusion: This study has demonstrated PCT as a more reliable diagnostic marker than CRP for early diagnosis of bacterial meningitis and can be used in combination with clinical evaluation for proper management of the seriously ill children.

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