ABSTRACT
OBJETIVOS: Analizar y comparar la capacidad de la procalcitonina (PCT) y la proteína C reactiva (PCR) para detectar meningitis bacteriana (MB) en los ancianos (mayores de 74 años). MÉTODOS: Estudio observacional, prospectivo, descriptivo y analítico de pacientes ≥ 1 año diagnosticados de meningitis aguda (MA) en un servicio de urgencias (SU) desde septiembre de 2009 hasta julio de 2014. RESULTADOS: Se incluyeron 220 casos diagnosticados de MA con una edad media de 30 ± 26 años, el 62% varones (136). De ellos, 83 pacientes de 1-14 años (17 con MB), 111 pacientes de 15-74 años (32 con MB) y 26 casos ≥ 75 años (17 con MB). Para predecir MB la PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,972 (IC 95%: 0,946-0,998, p < 0,001), y con un punto de corte ≥ 0,52 ng/ml se consigue una sensibilidad del 93% y una especificidad del 86%, y para los pacientes ≥ 75 años una sensibilidad del 96% y una especificidad del 75% con el mismo ABC-ROC de 0,972. La PCR consigue un ABC-ROC de 0,888 y con punto de corte ≥ 54,4 mg/l una sensibilidad de 91% y una especificidad de 78%, y para los pacientes ≥ 75 años solo un ABC-ROC de 0,514 con una sensibilidad de 97% y una especificidad del 43%. CONCLUSIONES: En todos los pacientes con MA en SU la PCT consigue un gran rendimiento diagnóstico para sospechar la etiología bacteriana, mayor que la PCR y leucocitos. Además, en los pacientes ancianos la PCR no tiene utilidad
OBJECTIVES: To analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis (BM) in the elderly (> 74 years of age). METHODS: A prospective, observational, descriptive, analytical study of 220 consecutive patients aged ≥ 1 year and diagnosed with acute meningitis in an emergency department between September 2009 and July 2014. RESULTS: A total of 220 patients (136 [62%] male) were studied. The mean age was 30 ± 26 years, with BM being diagnosed in 17/83 patients from 1 to 14 years of age, 32/111 from 15 to 74 years of age, and 17/26 patients ≥ 75 years of age. PCT had the highest area under the receiver operating characteristic curve (AUC) (0.972; 95% CI, 0.946-0,998; P < .001) to predict bacterial meningitis. With a cut-off of ≥ 0.52 ng/mL, PCT achieved 93% sensitivity and 86% specificity, and for patients over 75 years of age 96% sensitivity and 75% specificity, with the same AUC (0.972). The AUC for CRP was 0.888, and a ≥ 54,4 mg/L cut-off achieved 91% sensitivity and 78% specificity, and for patients over 75 years of age an AUC of only 0.514 achieved with 97% sensitivity and 43% specificity. CONCLUSIONS: For all patients with acute meningitis in the emergency department, PCT has a high diagnostic power, outperforming CRP and Leukocytes for detection of bacterial etiology, but CPR is of not useful in the elderly
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Calcitonin/analysis , C-Reactive Protein/analysis , Meningitis, Bacterial/physiopathology , Biomarkers/analysis , Meningitis, Bacterial/diagnosis , Emergency Medical Services/statistics & numerical data , Prospective Studies , Reproducibility of Results , Reproducibility of ResultsABSTRACT
OBJETIVES: To analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis (BM) in the elderly (>74 years of age). METHODS: A prospective, observational, descriptive, analytical study of 220 consecutive patients aged ≥1year and diagnosed with acute meningitis in an emergency department between September 2009 and July 2014. RESULTS: A total of 220 patients (136 [62%] male) were studied. The mean age was 30±26years, with BM being diagnosed in 17/83 patients from 1 to 14years of age, 32/111 from 15 to 74years of age, and 17/26 patients ≥75years of age. PCT had the highest area under the receiver operating characteristic curve (AUC) (0.972; 95%CI, 0.946-0,998; P<.001) to predict bacterial meningitis. With a cut-off of ≥0.52ng/mL, PCT achieved 93% sensitivity and 86% specificity, and for patients over 75years of age 96% sensitivity and 75% specificity, with the same AUC (0.972). The AUC for CRP was 0.888, and a ≥54,4mg/L cut-off achieved 91% sensitivity and 78% specificity, and for patients over 75years of age an AUC of only 0.514 achieved with 97% sensitivity and 43% specificity. CONCLUSIONS: For all patients with acute meningitis in the emergency department, PCT has a high diagnostic power, outperforming CRP and Leukocytes for detection of bacterial etiology, but CPR is of not useful in the elderly.
Subject(s)
C-Reactive Protein/analysis , Calcitonin/blood , Meningitis, Bacterial/diagnosis , Adolescent , Adult , Age Factors , Aged , Child , Child, Preschool , Emergency Service, Hospital , Female , Humans , Infant , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Calcitonin/analysis , C-Reactive Protein/analysis , Bacteremia/diagnosis , Immunocompromised Host , Emergency Medical Services/statistics & numerical data , Biomarkers/analysisSubject(s)
Bacteremia , C-Reactive Protein , Aged , Biomarkers , Humans , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
No disponible
