Öz
Giriş
Toplum kökenli santral sinir sistemi enfeksiyonları (TK-SSSE), belirgin morbidite ve mortalite ile ilişkilidir. Pürülan menenjit ile aseptik menenjitin erken dönemde ayırt edilmesi klinikte önemli bir sorun olmaya devam etmektedir. Başvuru sırasında rutin olarak elde edilebilen biyobelirteçler, bu ayrımı zamanında yapmaya yardımcı olabilir.
Gereç ve Yöntem
Üçüncü basamak bir eğitim ve araştırma hastanesinde, beş yıllık dönemde TK-SSSE nedeniyle yatırılarak izlenen ≥18 yaş erişkin hastalar retrospektif kohort tasarımında değerlendirildi. Epidemiyolojik, klinik ve laboratuvar veriler incelendi. Rutin biyobelirteçlerin tanısal performansı alıcı işletim karakteristiği eğrisi analizi ile değerlendirildi. Çok değişkenli analizde Firth penalizasyonlu lojistik regresyon kullanıldı; iç doğrulama bootstrap yeniden örnekleme ile yapıldı.
Bulgular
Çalışmaya 70 hasta dahil edildi (medyan yaş 45 yıl; %63 erkek). Olguların %46’sı pürülan menenjit, %24’ü aseptik meningoensefalit idi. Pürülan menenjitli hastalarda lökosit sayısı, C-reaktif protein (CRP) ve prokalsitonin düzeyleri anlamlı olarak daha yüksek; beyin omurilik sıvısı (BOS)/serum glukoz oranı ise daha düşüktü. Pürülan ve aseptik menenjitin ayrımında en yüksek ayırt edici gücü BOS/serum glukoz oranı gösterdi [eğri altındaki alan (AUC) 0,97]; bunu CRP izledi (AUC: 0,89). Çok değişkenli analizde BOS/serum glukoz oranı pürülan menenjit ile bağımsız olarak ilişkili bulunurken, CRP ek ayırt edicilik sağladı.
Sonuç
Bu kohortta pürülan ve aseptik menenjitin ayırıcı tanısında en güçlü başvuru biyobelirteci BOS/serum glukoz oranı olarak saptandı. CRP’nin ek katkısı, TK-SSSE şüphesi olan hastalarda erken klinik karar vermeyi desteklemek amacıyla rutin biyobelirteçlerin birlikte değerlendirilmesini desteklemektedir.
Anahtar Kelimeler:
Santral Sinir sistemi enfeksiyonları, bakteriyel menenjit, aseptik menenjit, serebrospinal sıvı, biyobelirteçler, C-reaktif protein
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