QJM Advance Access published online on January 30, 2008
QJM, doi:10.1093/qjmed/hcm146
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The value of serial cerebrospinal fluid 14-3-3 protein levels in adult community-acquired bacterial meningitis
1From the Department of Neurology, 2Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, 3Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, 4Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Taipei and 5Department of Neurosurgery Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Address correspondence to Dr C.-H. Lu, MD, MSc, Department of Neurology, Chang Gung Memorial Hospital, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan. email: chlu99{at}pchome.com.tw
Received 5 August 2007 Accepted for publication 3 November 2007.
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Abstract |
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Background: Increased levels of cerebrospinal fluid (CSF) 14-3-3 proteins have been reported in acute bacterial meningitis. We tested the hypothesis that CSF 14-3-3 protein levels are substantially increased in acute bacterial meningitis and decreased after anti-microbial therapy, and that CSF 14-3-3 protein levels can predict treatment outcomes.
Methods: We examined serial pan-CSF 14-3-3 (14-3-3-P) protein and five major isoform (β, 
, 
, 
, 
) levels in 29 adult community-acquired bacterial meningitis (ACABM) patients. The CSF 14-3-3 protein levels were also evaluated in 12 aseptic meningitis patients during the study period.
Results: All of the meningitis patients had a positive result on admission. Levels of CSF 14-3-3 protein in ACABM cases were significantly increased initially, and substantially decreased thereafter. Most of those who survived (survivors = 25 and non-survivors = 4) had nearly cleared their 14-3-3 protein from the CSF before discharge. Conversely, patients who died never cleared their CSF 14-3-3 protein. The median value of CSF 14-3-3-P and 14-3-3 , 14-3-3 and 14-3-3 isoforms on admission in the bacterial meningitis group were 173.7, 137.7, 42.2 and 9.1, respectively, which were statistically significant than those of the aseptic meningitis group (48.4, 39.6, 2.5 and 0, respectively). Stepwise logistic regression analysis showed only CSF 14-3-3 isoform on admission was independently associated with outcome (P = 0.05, OR = 0.991).
Conclusions: Serial 14-3-3 protein isoform actually meets the major requirements for outcome prediction in the treatment of ACABM patients. Assay of the 14-3-3 protein isoform should be added as a neuro-pathologic marker among the panel of conventional CSF parameters.