Heparin-Binding Protein as a Diagnostic Biomarker for Healthcare-Associated Meningitis and Ventriculitis in Pediatric Patients.
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BACKGROUND AND OBJECTIVES: Early and accurate diagnosis of meningitis and ventriculitis after craniotomy is still quite challenging. The research aimed to examine if cerebrospinal fluid (CSF) heparin-binding protein (HBP) can enhance the accuracy in diagnosing healthcare-associated meningitis or ventriculitis in children compared with lactate and procalcitonin (PCT). METHODS: Children with craniotomy for ventricular system tumors were eligible for this prospective observational cohort study. Heparin-binding protein, PCT, white blood cell count, glucose, protein, and lactate in CSF were tested when children were suspected of developing CSF infections, as were Gram staining and cultures. RESULTS: Among 122 eligible participants, 116 with 279 samples were enrolled in the final analysis, including 71 children (142 samples) with healthcare-associated meningitis or ventriculitis as the infected group and 45 children (137 samples) with no CSF infections as the control group. Heparin-binding protein presented a substantially increased pattern in patients with postoperative meningitis or ventriculitis contrasted with control patients (180 [120-212] ng/mL in the infected group vs 12 [3-58] ng/mL in the controls). Heparin-binding protein achieved the highest area under the receiver operating characteristic curve of 0.93 (95% confidence interval, 0.91-0.96), a sensitivity of 89%, a specificity of 81%, a positive predictive value of 83%, and a negative predictive value of 87% with a cutoff value of >74 ng/mL, followed by lactate (0.90 [0.87-0.94]) and PCT (0.66 [0.60-0.73]). The protein was the only biomarker that elevated significantly in all culture-positive patients without the influence of empiric antibiotics. CONCLUSION: CSF HBP is a more accurate candidate biomarker superior to lactate and PCT for diagnosing healthcare-associated meningitis and ventriculitis among pediatric patients. Early HBP analysis of CSF in suspected patients may facilitate early detection of CSF infections.