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Diagnostic Model for Discrimination Between Tuberculous Meningitis and Bacterial Meningitis.
- Source :
-
Frontiers in immunology [Front Immunol] 2021 Nov 12; Vol. 12, pp. 731876. Date of Electronic Publication: 2021 Nov 12 (Print Publication: 2021). - Publication Year :
- 2021
-
Abstract
- Background: The differential diagnosis between tuberculous meningitis (TBM) and bacterial meningitis (BM) remains challenging in clinical practice. This study aimed to establish a diagnostic model that could accurately distinguish TBM from BM.<br />Methods: Patients with TBM or BM were recruited between January 2017 and January 2021 at Tongji Hospital (Qiaokou cohort) and Sino-French New City Hospital (Caidian cohort). The detection for indicators involved in cerebrospinal fluid (CSF) and T-SPOT assay were performed simultaneously. Multivariate logistic regression was used to create a diagnostic model.<br />Results: A total of 174 patients (76 TBM and 98 BM) and another 105 cases (39 TBM and 66 BM) were enrolled from Qiaokou cohort and Caidian cohort, respectively. Significantly higher level of CSF lymphocyte proportion while significantly lower levels of CSF chlorine, nucleated cell count, and neutrophil proportion were observed in TBM group when comparing with those in BM group. However, receiver operating characteristic (ROC) curve analysis showed that the areas under the ROC curve (AUCs) produced by these indicators were all under 0.8. Meanwhile, tuberculosis-specific antigen/phytohemagglutinin (TBAg/PHA) ratio yielded an AUC of 0.889 (95% CI, 0.840-0.938) in distinguishing TBM from BM, with a sensitivity of 68.42% (95% CI, 57.30%-77.77%) and a specificity of 92.86% (95% CI, 85.98%-96.50%) when a cutoff value of 0.163 was used. Consequently, we successfully established a diagnostic model based on the combination of TBAg/PHA ratio, CSF chlorine, CSF nucleated cell count, and CSF lymphocyte proportion for discrimination between TBM and BM. The established model showed good performance in differentiating TBM from BM (AUC: 0.949; 95% CI, 0.921-0.978), with 81.58% (95% CI, 71.42%-88.70%) sensitivity and 91.84% (95% CI, 84.71%-95.81%) specificity. The performance of the diagnostic model obtained in Qiaokou cohort was further validated in Caidian cohort. The diagnostic model in Caidian cohort produced an AUC of 0.923 (95% CI, 0.867-0.980) with 79.49% (95% CI, 64.47%-89.22%) sensitivity and 90.91% (95% CI, 81.55%-95.77%) specificity.<br />Conclusions: The diagnostic model established based on the combination of four indicators had excellent utility in the discrimination between TBM and BM.<br />Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.<br /> (Copyright © 2021 Luo, Xue, Lin, Mao, Tang, Song, Liu, Wu, Liu, Zhou, Xu, Xiong, Wang, Yuan, Gan, Sun and Wang.)
- Subjects :
- Adult
Antigens, Bacterial cerebrospinal fluid
Biomarkers blood
Biomarkers cerebrospinal fluid
Cerebrospinal Fluid cytology
Cerebrospinal Fluid immunology
Cerebrospinal Fluid microbiology
China
Cohort Studies
Diagnosis, Differential
Enzyme-Linked Immunospot Assay methods
Female
Humans
Interferon-gamma blood
Male
Meningitis, Bacterial blood
Meningitis, Bacterial cerebrospinal fluid
Middle Aged
Models, Biological
Mycobacterium tuberculosis immunology
Mycobacterium tuberculosis isolation & purification
Tuberculosis, Meningeal blood
Tuberculosis, Meningeal cerebrospinal fluid
Meningitis, Bacterial diagnosis
Tuberculosis, Meningeal diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1664-3224
- Volume :
- 12
- Database :
- MEDLINE
- Journal :
- Frontiers in immunology
- Publication Type :
- Academic Journal
- Accession number :
- 34867952
- Full Text :
- https://doi.org/10.3389/fimmu.2021.731876