Diagnostic Accuracy of the Combination of Cerebrospinal fluid and blood Presepsin for Postoperative Meningitis after Neurosurgery: Single-Center Prospective Observational Cohort Study

Abstract

Abstract Objective: Post-neurosurgical meningitis (PNM) is a serious complication in neurocritical care patients, leading to clinical deterioration and worsening outcomes. Accurate diagnosis of PNM is often difficult due to the lack of a definitive diagnostic biomarker. This study investigated the usefulness of cerebral spinal fluid (CSF) and blood presepsin (PSP) for the diagnosis of PNM. Methods: We conducted a single-center prospective observational study at Nara Prefecture General Medical Center in Nara, Japan, from April 2020 to March 2022. The postoperative neurosurgical patients with suspected PNM were included in the study and divided into PNM and non-PNM groups. We evaluated the sensitivity, specificity, area under curves (AUCs), positive predictive value (PPV), and negative predictive value (NPV) for the diagnosis of PNM with CSF PSP, blood PSP, and CSF/blood PSP ratio compared in the two groups. Results: 27 patients suspected of PNM were included and 9 patients were clinical diagnosis with PNM. The results of CSF PSP (cut-off: 548 pg/mL) for the diagnosis of PNM were sensitivity 89%, specificity 72%, PPV 62%, and NPV 93%, AUC 0.76 [95% confidence interval (CI), 0.54–0.98], blood PSP (cut-off: 226 pg/mL) was 78%, 56%, 47%, and 83%, 0.63 [95% CI, 0.40–0.87], and those of CSF/blood PSP ratio (cut-off: 3.79) was 67%, 83%, 67%, and 83%, 0.77 [95% CI, 0.58–0.97]. Conclusion: This current study suggested that CSF PSP and CSF/blood PSP ratio may be useful indicators for the diagnostic accuracy of PNM.