Diagnostic Model for Discrimination Between Tuberculous Meningitis and Bacterial Meningitis

作者：Ying Luo, Ying Xue, Qun Lin, Liyan Mao, Guoxing Tang, Huijuan Song, Wei Liu, Shiji Wu, Weiyong Liu, Yu Zhou, Lingqing Xu, Zhi‐Gang Xiong, Ting Wang, Yuan Xu, Yong Gan, Ziyong Sun, Feng Wang · 发表于：Frontiers in Immunology · 年份：2021 · DOI：10.3389/fimmu.2021.731876 · 被引用次数：18 · 研究领域：Infectious Diseases and Tuberculosis、Bacterial Infections and Vaccines、Pneumonia and Respiratory Infections

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. 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. 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...