Cerebrospinal fluid lipocalin-2 and bactericidal/permeability-increasing protein in acute bacterial versus viral meningitis: a prospective study.

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PURPOSE: Distinguishing acute bacterial meningitis (ABM) from acute viral meningitis (AVM) remains challenging in clinically ambiguous scenarios, particularly during early disease stages or following partial antibiotic treatment. This study aimed to evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) lipocalin-2 (LCN-2) and Bactericidal/Permeability-Increasing Protein (BPI) for the rapid differentiation of ABM from AVM.

METHODS: In this prospective study (November 2020-October 2021), 90 adult patients were categorized into ABM, AVM, and control groups based on clinical and laboratory definitions. CSF LCN-2 and BPI levels were quantified using enzyme-linked immunosorbent assay (ELISA). Group comparisons were performed using Mann-Whitney U and Kruskal-Wallis tests. Diagnostic performance was evaluated using Receiver Operating Characteristic (ROC) curve analyses to determine sensitivity, specificity, and optimal cut-off values.

RESULTS: Analysis of a cohort of 90 patients revealed that CSF LCN-2 levels were significantly higher in the ABM group (median: 103.2 ng/mL) compared to the AVM group (median: 99.3 ng/mL; p = 0.003) and controls (p < 0.001). Applying a threshold of greater than 100.7 ng/mL, LCN-2 differentiated ABM from AVM with a sensitivity of 83.3% and a specificity of 60.0%. In contrast, CSF BPI levels did not demonstrate significant diagnostic value (p > 0.05).

CONCLUSION: CSF LCN-2 demonstrated high sensitivity as a biomarker for distinguishing ABM from AVM, indicating its potential as an adjunctive tool for early clinical decision-making. In contrast, BPI did not demonstrate adequate diagnostic utility in this cohort. Further multicenter studies with larger sample sizes are necessary to confirm the clinical applicability of LCN-2.