Severity assessment of central nervous system infections by determining the level of myeloperoxidase protein in neutrophil extracellular traps (NETs) in cerebrospinal fluid: a retrospective case-control study

Abstract

Abstract Background and objectives: Central nervous system (CNS) infections, represented by encephalitis, are life-threatening conditions frequently encountered by neurologists. Timely and accurate diagnosis is essential for implementing effective treatment. The objective of this study is to explore the impact of central nervous system infectious diseases on patient prognosis through the detection of myeloperoxidase (MPO) protein in neutrophil extracellular traps (NETs) in cerebrospinal fluid. Methods This retrospective case-control study was conducted in the Neurology Ward of Shandong University Second Hospital, involving patients diagnosed with infectious encephalitis confirmed by PCR and other methods from January 2018 to January 2024. The presence of MPO protein in the cerebrospinal fluid of the patients was measured using an ELISA method. Results We enrolled 50 patients diagnosed with infectious encephalitis by means of PCR testing and divided them into three groups: purulent meningitis (n = 25), viral encephalitis (n = 25), and a control group of non-infectious disease patients (n = 25). After normalality testing, there was a significant difference in the MPO content between the purulent meningitis group and the other two groups (P<0.0001). We subsequently analyzed the general data of the purulent meningitis group and the control group, and found that blood leukocyte count, cerebrospinal fluid (CSF) leukocyte count, and CSF protein content were also different between the two groups. Correlation analysis revealed a high correlation between MPO and blood leukocyte count (R2 = 0.36, P = 0.0015), CSF leukocyte count (R2 = 0.53, P<0.0001), and CSF albumin content (R2 = 0.34, P = 0.0019), indicating that MPO could serve as one of the diagnostic indicators for purulent meningitis. Using the ROC curve analysis, we found that when MPO ≥ 14.625ng/ml, the prognosis of purulent meningitis was poor, with slow patient recovery, and an accuracy of 98.7%. Conclusion The measurement of MPO levels in cerebrospinal fluid samples obtained after admission can aid in the diagnosis of Suppurative meningitis.