Peer-reviewedCC BYBrain & spine7 Oct 2026

Cerebrospinal fluid C-reactive protein to diagnose healthcare-associated meningitis after neurosurgical procedures: An exploratory retrospective diagnostic accuracy study.

M Foppen^1,2
I O Kommers¹
S E Olie³
H H M Schotman⁴
D Verbaan¹
M C Brouwer³

4 affiliations

¹Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands.
²Department of Neurosurgery, Erasmus Medical Center, Erasmus University Rotterdam, the Netherlands.
³Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands.
⁴Department of Laboratory Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.

Abstract

Introduction

Neurosurgical procedures are frequently complicated by postoperative meningitis. Current diagnostic methods are insufficient and time-consuming. Cerebrospinal fluid C-reactive protein (CSF CRP) has shown excellent diagnostic accuracy for patients with a community-acquired meningitis and can be determined quickly.Research question

This study investigates the diagnostic accuracy of CSF CRP for detecting postoperative meningitis.Materials and methods

We performed a retrospective monocenter cohort study, including patients in whom a postoperative meningitis was suspected within 30 days after neurosurgery. To assess the diagnostic accuracy of CSF CRP, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating curve (ROC) and area under the curve (AUC) with 95% confidence interval (CI) were calculated.Results

Forty-five patients were included of whom 8 (18%) were diagnosed with postoperative meningitis. Two of eight patients (25%) with a meningitis had a detectable CSF CRP concentration (>0.30 mg/L) compared to eighteen of 37 (49%) without a meningitis. With a cut-off value of 0.30 mg/L, CSF CRP had a 25% sensitivity, 51% specificity, 10% PPV and 76% NPV. The AUC was 0.43 (95% CI 0.22-0.66).Discussion and conclusion

The diagnostic accuracy of CSF CRP to diagnose a postoperative meningitis is poor and treatment decisions should not be based on this parameter.

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Cite

BibTeX RIS

BibTeX

@article{foppen2026cerebrospinal,
  title = {{Cerebrospinal fluid C-reactive protein to diagnose healthcare-associated meningitis after neurosurgical procedures: An exploratory retrospective diagnostic accuracy study.}},
  author = {M Foppen and I O Kommers and S E Olie and H H M Schotman and D Verbaan and M C Brouwer},
  journal = {Brain \& spine},
  year = {2026},
  month = oct,
  doi = {10.1016/j.bas.2026.107466},
  url = {https://europepmc.org/article/MED/42898232},
  note = {CC BY},
}

RIS

TY  - JOUR
TI  - Cerebrospinal fluid C-reactive protein to diagnose healthcare-associated meningitis after neurosurgical procedures: An exploratory retrospective diagnostic accuracy study.
AU  - M Foppen
AU  - I O Kommers
AU  - S E Olie
AU  - H H M Schotman
AU  - D Verbaan
AU  - M C Brouwer
PY  - 2026
DA  - 2026/10/07
JO  - Brain & spine
DO  - 10.1016/j.bas.2026.107466
UR  - https://europepmc.org/article/MED/42898232
AB  - Introduction  Neurosurgical procedures are frequently complicated by postoperative meningitis. Current diagnostic methods are insufficient and time-consuming. Cerebrospinal fluid C-reactive protein (CSF CRP) has shown excellent diagnostic accuracy for patients with a community-acquired meningitis and can be determined quickly.Research question  This study investigates the diagnostic accuracy of CSF CRP for detecting postoperative meningitis.Materials and methods  We performed a retrospective monocenter cohort study, including patients in whom a postoperative meningitis was suspected within 30 days after neurosurgery. To assess the diagnostic accuracy of CSF CRP, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating curve (ROC) and area under the curve (AUC) with 95% confidence interval (CI) were calculated.Results  Forty-five patients were included of whom 8 (18%) were diagnosed with postoperative meningitis. Two of eight patients (25%) with a meningitis had a detectable CSF CRP concentration (>0.30 mg/L) compared to eighteen of 37 (49%) without a meningitis. With a cut-off value of 0.30 mg/L, CSF CRP had a 25% sensitivity, 51% specificity, 10% PPV and 76% NPV. The AUC was 0.43 (95% CI 0.22-0.66).Discussion and conclusion  The diagnostic accuracy of CSF CRP to diagnose a postoperative meningitis is poor and treatment decisions should not be based on this parameter.
SN  - 2772-5294
ER  -

Abstract

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