Aim: The aim of this study was to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in comparison to procalcitonin (PCT) and C-reactive protein (CRP) in early diagnosis of septic meningitis and its usefulness to distinguish between septic and aseptic meningitis. Patients and methods: This study included 26 patients with septic meningitis, 32 patients with aseptic meningitis and 15 controls. Besides Gram staining, cultures of blood and CSF and

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... latex agglutination test of CSF, CRP, serum PCT and sTREM-1 measurement were done on admission and after 48-72 h of treatment. Results: Septic meningitis was diagnosed in 26 (44.82%) of the studied cases. Patients with septic meningitis had a significant increase in serum sTREM-1 and PCT levels at the time of admission (mean 32.99 ± 19.7 ng/ml and 97.9 ± 86.35 ng/ml, respectively), while patients with aseptic meningitis showed (6.8 ± 5.67 ng/ml and 1.88 ± 1.6 ng/ml, respectively). Control group showed sTREM-1 and PCT levels (6.6 ± 4.6 ng/ml and 0.58 ± 0.36 ng/ml, respectively) (P < 0.05). sTREM-1 demonstrated significantly higher sensitivity (93.7%) and specificity (94.3%) in the early prediction of sepsis with an area under the receiver operator characteristic (ROC) curve (95% CI) of 0.94 (0.84-0.99) at a cut off value of 12.4 ng/ml. Moreover, sTREM-1 but not PCT or CRP concentration was significantly lower (P < 0.001) at admission in patients with poor outcome than in those with good prognosis. Conclusions: Both serum PCT and sTREM-1 are valuable in the early distinguishing of septic from aseptic meningitis in children but with markedly higher diagnostic discriminatory power for sTREM-1. Moreover, sTREM-1 has a significant value in determining the prognosis of cases with septic meningitis.