Clinical characteristics of childhood purulent meningitis and its risk factors for adverse prognosis / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the clinical characteristics of childhood purulent meningitis (PM)and the risk factors for its adverse outcome.Methods One hundred and nine children with PM were retrospective ana-lyzed,who were admitted to pediatric department in Xijing Hospital of the Fourth Military Medical University from Ja-nuary 2008 to July 201 6.They were divided into 5 age groups,the clinical features were compared among the different age groups.According to Glasgow prognostic score,all cases were then divided into 2 groups,the favorable outcome group and the adverse outcome group.All factors including normal information,disease history,clinical manifestations and laboratory examinations were compared between 2 groups.Results There were 72.5% (79 /1 09 cases)of the pa-tients younger than 3 years old.PMwas prone to spring and winter,and most children with PMhad preceding infection. The major clinical manifestations of PM were fever,convulsions and intracranial hypertension.The clinical manifesta-tions of PMwere different in different age groups,and convulsions were more commonly seen in less than 3 years old children,while headache,vomiting and meningeal stimulation had higher proportion in more than 3 years old children. The single factor analysis showed that there were repeated convulsions after admission (≥3 times),the cerebrospinal fluid (CSF)glucose(≤1 .5 mmol/L),CSF protein(≥1 g/L),CSF /blood glucose ratio and complications were signifi-cantly different between 2 groups(all P 500 ×1 06 /L,blood and CSF cultivate positive rate, co -infection,brain CT/MRI abnormality,electroencephalogram abnormality,treatment and duration of seizure more than 5 minutes were not significantly different(all P >0.05).Multivariate analysis showed that there were repeated convulsions after admission (≥3 times)(OR =27.84,P =0.048),CSF protein(≥1 g/L)(OR =28.44,P =0.027) and low CSF /blood glucose ratio (OR =22.1 5,P =0.041 )were independent risk factors for poor prognosis of PM. Conclusion PMhappens mostly in infantile period,with different clinical manifestations at different ages.The inde-pendent risk factors for poor prognosis were repeated convulsions after admission (≥3 times),CSF protein(≥1 g/L) and low CSF /blood glucose ratio.It indicates that if the high risk factors could be identified early,and then intervened immediately and followed up timely,it will be beneficial to improve the long -term prognosis.