J Korean Neurol Assoc > Volume 21(3); 2003 > Article

Journal of the Korean Neurological Association 2003;21(3): 248-254.

성인 뇌수막염의 감별 진단에서 C-Reactive Protein의 예측적 의의

박정욱 , 정성우 고석범 최영빈 이광수

가톨릭대학교 의과대학 신경과학교실

"Predictive Value of C-Reactive Protein in the Differential Diagnosis of Acute Meningitis in Adults"

Jeong-Wook Park

Department of Neurology, College of Medicine, The Catholic University of Korea

Abstract

"Background: The aim of this study was to clarify to what extent bacterial meningitis could be distinguished from aseptic or tuberculous meningitis through C-reactive protein (CRP) in adults.
Methods: We retrospectively analyzed the medical records of 91 patients aged 15~81 years who had been hospitalized for acute meningitis and underwent lumbar puncture due to suspected central nervous system infection.
Results: We included 50 patients with aseptic meningitis, 23 patients with acute bacterial meningitis, and 18 patients with tuberculous meningitis. Blood CRP was higher in bac-terial meningitis. None of the patients with bacterial meningitis had a CRP value of under 20 mg/dl. The CRP values were under 20 mg/dl in 92% of the patients with aseptic meningitis and in 73% of those with tuberculous meningitis. Taking a CRP level of above 20 mg/dl as a positive discriminatory factor for bacterial meningitis, the sensitivity and specificity were 1.0, 0.88. To better predict whether a patient has bacterial or nonbacterial meningitis, we developed a canonical discriminant function equation using CRP and CSF parameter, and finally concluded that blood CRP was a good predictive indicator that differentiated bacterial meningitis from aseptic or tuberculous meningitis at admission. C o n c l u s I o n s: The CRP measurement, is easily performed and inexpensive. We believe it is worth analyzing CRP whenever meningitis is suspected, it can also limit the unnecessary use of antibiotics.Key Words: Meningitis, C-reactive protein, Cerebrospinal fluid, Discriminant analysis"