Diagnostic Value of C-Reactive Protein and C-Reactive Protein-to-Albumin Ratio in Differentiating Bacterial from Viral Meningitis

Objective: To evaluate the diagnostic efficiency of C-reactive protein (CRP) and CRP-to-albumin ratio (CAR) in differentiating bacterial meningitis from viral meningitis Study Type: Cross-sectional study Place and Duration of Study: Department of Neurology and Medicine, Pakistan Emirates Military Hospital, Rawalpindi, Pakistan, from Dec 23 to May 24 Methodology: Patients of both genders ≥18 years old with suspected or confirmed diagnosis of meningitis, either viral or bacterial, were included. Patients with sepsis, systemic infections other than CNS, and protein-losing nephropathies were excluded. After a detailed relevant history and examination, samples for serum CRP, albumin, and cerebrospinal fluid were collected. The patient was labelled as a case of bacterial or viral meningitis based on clinical history, examination, and cerebrospinal fluid (CSF) studies. Results: A total of ninety-four (n=94) individuals with a mean age of 50.86±11.80 years were included. The mean serum albumin was 32.57±3.23 g/L, while the median CRP level was 27.50 (16.75-53.00) mg/L. The median CAR was 0.78 (0.53-1.75). In patients, fever (92; 97.87%) was the most common symptom, followed by vomiting (57; 60.64%) and headache (54; 57.45%). The serum albumin levels and patients’ age had no relation to meningitis variants, as p-value was 0.344 and 0.111, respectively. The serum CRP levels and CAR were strongly related to the type of meningitis, with p<0.001. Conclusion: The serum CRP to Albumin ratio, along with serum CRP levels, can be used as a tool to differentiate bacterial from viral meningitis, at least when cultures and CSF studies are awaited, and prompt prophylactic