CPJXXX10.1177/0009922815569203Clinical PediatricsHu et al

Original Article

Relationship of Serum Procalcitonin Levels to Severity and Prognosis in Pediatric Bacterial Meningitis

Clinical Pediatrics 1­–4 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922815569203 cpj.sagepub.com

Ruimei Hu, MD1, Yansheng Gong, BSMed2, and Yuzhen Wang, MPH1

Abstract Objective. To investigate the relationship between serum procalcitonin (PCT) levels and prognosis in children with bacterial meningitis. Methods. Eighty-two child patients were included in this prospective study. The diagnosis of meningitis was based on clinical features and cerebrospinal fluid findings. PCT levels were measured with a specific immunoluminometric assay. Results. (a) Patients with bacterial meningitis had significantly higher serum PCT than those with viral meningitis. (b) The PCT levels of patients with severe sepsis or septic shock were significantly higher than those who had no or mild sepsis. (c) PCT levels decreased significantly in patients who had good curative effect, whereas PCT levels did not changed in patients who had no curative effect. (d) The PCT levels were significantly higher in those who died than those who survived. Conclusions. Serum PCT is related to the severity of disease in children with bacterial meningitis. A fall in PCT after treatment may have favorable prognostic significance. Keywords procalcitonin, prognosis, meningitis

Introduction Central nervous system infection is a common disease in children. Bacterial meningitis needs antibiotic treatment and carries a risk of serious sequelae in affected children. In comparison, viral meningitis usually has a good outcome and does not need expensive antibiotics. The differentiation between bacterial and viral meningitis is based primarily on the results of cerebrospinal fluid examinations. These usually include the number and type of leukocytes, concentration of protein and glucose, Gram staining, and cultures. Sometimes these indices are insufficient for accurate diagnosis because of overlap in the typical laboratory findings, such as cerebrospinal fluid leukocyte number. It would be better to be able to differentiate viral from bacterial disease at the time of initial assessment. Sometimes bacterial meningitis is life-threatening, so it is important to distinguish severe cases from the common ones. Procalcitonin (PCT) is a glycopeptide consisting of 116 amino acids produced under normal conditions in the C cells of the thyroid gland as the precursor molecule of calcitonin. In healthy subject, the PCT serum levels are undetectable or very low. In 1993, PCT was first described as a prognostic indicator and marker of

the extent and course of the systemic inflammatory response to bacterial infection.1 Several subsequent studies demonstrated that PCT levels are closely related to severe invasive bacterial infections and decrease rapidly after appropriate antibiotic therapy. The persistence of PCT high values is a predictor of unfavorable outcome of severe septic patients.2 The unique feature that PCT levels increase in bacterial infections, but remain unchanged even in severe viral infections and other inflammatory diseases, makes PCT attractive as a potential diagnostic variable for the diagnosis of bacterial meningitis.3 The aim of the present study was to see if PCT is useful in differentiating between bacterial meningitis and viral meningitis. We also describe the variation in serum PCT levels over time during the treatment of bacterial meningitis.


Qilu Hospital, Shandong University, Jinan, China Shandong Academy of Chinese Medicine, Jinan, China


Corresponding Author: Ruimei Hu, Qilu Hospital, Shandong University, Wenhuaxi Road, Jinan, 250012, China. Email: [email protected]

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Clinical Pediatrics 

Table 1.  Comparison of Serum PCT, CRP, and Peripheral WBC Between the 2 Groups. Group Bacterial meningitis Viral meningitis P

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Relationship of Serum Procalcitonin Levels to Severity and Prognosis in Pediatric Bacterial Meningitis.

To investigate the relationship between serum procalcitonin (PCT) levels and prognosis in children with bacterial meningitis...
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