Clinical, biochemical and microbiological factors associated with the prognosis of pneumococcal meningitis in children

BackgroundPneumococcal meningitis (PM) has a high morbidity and mortality. The aim of the study was to evaluate what factors are related to a poor PM prognosis.MethodsProspective observational study conducted on patients admitted to the Pediatric Intensive Care Unit in a tertiary hospital with a diagnosis of PM (January 2000 to December 2013). Clinical, biochemical and microbiological data were recorded. Variable outcome was classified into good or poor (neurological handicap or death). A multivariate logistic regression was performed based on the univariate analysis of significant data.ResultsA total of 88 patients were included. Clinical variables statistically significant for a poor outcome were younger age (p = .008), lengthy fever (p = .016), sepsis (p = .010), lower Glasgow Score (p < .001), higher score on Pediatric Risk Mortality Score (p = 0.010) and Sequential Organ Failure Assessment (SOFA) (p < .001), longer mechanical ventilation (p = .004), and inotropic support (p = .008) requirements. Statistically significant biochemical variables were higher level of C-reactive protein (p < .001) and procalcitonin (p = .014) at admission, low cerebrospinal (CSF) pleocytosis (p = .003), higher level of protein in CSF (p = .031), and severe hypoglycorrhachia (p = .002). In multivariate analysis, independent indicators of poor outcome were age less than 2 years (p = .011), high score on SOFA (p = .030), low Glasgow Score (p = .042), and severe hypoglycorrhachia (p = .009).ConclusionsPatients younger than 2 years of age, with depressed consciousness at admission, especially when longer mechanical ventilation is required, are at high risk of a poor outcome.

ResumenIntroducciónLas meningitis neumocócicas (MN) se relacionan con una elevada morbimortalidad. El objetivo del estudio es evaluar qué factores se relacionan con un peor pronóstico.MétodosEstudio prospectivo observacional con pacientes diagnosticados de MN ingresados en la Unidad de Cuidados Intensivos Pediátricos de un hospital de tercer nivel (enero 2000-diciembre 2013). El pronóstico fue clasificado en buena o mala evolución (secuelas neurológicas o muerte). Se realizó un análisis multivariante de los resultados significativos obtenidos en el análisis univariante.ResultadosSe reclutaron 88 pacientes. Las variables clínicas relacionadas de forma estadísticamente significativa con una peor evolución fueron: menor edad (p = 0,008), mayor duración de la fiebre (p = 0,016), sepsis (p = 0,010), menor puntuación en la Escala de Glasgow (p < 0,001), mayor puntuación en Pediatric Risk Mortality Score (p = 0,010) y Sequential Organ Failure Assessment (SOFA) (p < 0,001), ventilación mecánica (p = 0,004) y soporte inotrópico (p = 0,008) prolongados. Las bioquímicas fueron: mayor elevación de proteína C reactiva (p < 0,001) y de procalcitonina (p = 0,014) al ingreso, menor pleocitosis en líquido cefalorraquídeo (p = 0,003), intensas proteinorraquia (p = 0,013) e hipoglucorraquia (p = 0,002). En el análisis multivariante, los factores independientes relacionados con una peor evolución fueron: edad inferior a 2 años (p = 0,011), elevada puntuación en SOFA (p = 0,030), menor puntuación en la Escala de Glasgow (p = 0,042) e hipoglucorraquia intensa (p = 0,009).ConclusionesLos menores de 2 años con mayor depresión del sensorio al ingreso, especialmente cuando requieren soporte ventilatorio prolongado, tienen un mayor riesgo de mala evolución.