Pentraxin-3 in central nervous system infections: A promising but limited biomarker?

Abstract

Central nervous system (CNS) infections lead to high morbidity and mortalitty rates, so there is a need for rapid and reliable biomarkers in diagnosis. The aim of this study was to determine the diagnostic value of Pentraxin-3 (PTX3) levels in CNS infections and to compare these with classic parameters. The study included 42 adult patients diagnosed with CNS infection between July 2020 and August 2021. The cerebral spinal fluid (CSF) and serum PTX3 levels were measured with the ELISA method. The findings were compared with clinical and laboratory parameters. The diagnostic performance was evaluated with ROC curve analysis. Bacterial meningitis was diagnosed in 39.0% of the patients, viral encephalitis in 51.2%, tuberculous meningitis in 7.3%, and fungal meningitis in 2.4%. The mortality rate was determined to be 43.9%. The CSF PTX3 levels were found to be higher in the bacterial cases, but with no significant difference between the serum and CSF PTX3 levels (p=0.327). A negative correlation was determined between CSF PTX3 and the Glasgow Coma Score, and a positive correlation between CSF PTX3 and the CSF protein level. In the ROC analyses, the strongest parameters for differentiation of bacterial and aseptic meningitis were seen to be CSF cell count (AUC: 0.888) and PMN percentage (AUC:0.882, while CSF PTX3 (AUC:0.586) and serum PTX3 (AUC:0.561) had the lowest differentiating power. PTX3 can be measured in CNS infections and higher levels are seen in bacterial meningitis cases. However, according to the ROC analysis results the diagnostic power is limited and these parameters lag behind classic CSF parameters. Therefore, PTX3 alone is not sufficient, but when combined with other biomarkers it can contribute to the clinical diagnostic process. The specific contribution of this study is that by evaluating both CSF and serum PTX3 levels simultaneously a relationship was determined between local and systemic inflammation.

Keywords

• Central nervous system infections
• Pentraxin 3
• Cerebrospinal fluid

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