[Prognostic factors in adults with community-acquired bacterial meningitis in intensive care unit]

ABSTRACT

Bacterial meningitis is a serious disease with a high mortality. The severe forms need an early management at the intensive care unit. We report a retrospective study over 14 years [1992- 2006] in medical intensive care unit. We studied demographic clinics, biologic, therapeutic variables, and the outcomes in patients aged > 16 years and presented with community-acquired bacterial. The variables were compared between surviving and died group. Statistic t test, Chi2, regression logistic. 201 patients were included. [139 men/ 62 women, age 35 +/- 16 years SAPSII 6,4 +/- 4,5]. 51 episodes of bacterial meningitis presented with altered mental status [Glasgow coma scale [GCS] was 12 +/- 3]. Overall mortality rate was 19, 9%. On unvaried analysis, the factors associated with mortality were age over 60 years, presence of a clinical symptoms > 72 hours before hospitalisation, GCS of 10 or less, visceral failure, lack of neck stiffness, heart rate >100 b/min, a high respiratory frequency, mean arterial blood pressure < 90 mm Hg, APACHE II score more than 12 during the 24 hours of admission, blood glucose level > 1,8 g/l and CSF glucose levels lower than 0,4 g/l. in the multivariate model seven conditions were significantly associated with mortality age over 40 years [Odds Ratio [OR] = 4,7 ; IC 95% 1,6 +/- 13,6], presence of symptoms >3days before admission [OR = 2,5 IC 95% 3,2 +/- 47,8], low score of GCS[OR = 4,1 IC 95% 1,4 +/- 11,6], respiratory rate> 30 cycles /min [OR = 7,3 IC 95% 1,7 CSF +/- 32,3], presence of shock chock [OR = 19,8 ; IC 95% 4,1 +/- 96], blood glucose level > 2 g/l [OR = 5,1 IC95% 1,5 +/- 17,2] and CSF glucose level < 0,4 gl [OR = 5,1 ; IC 95% 1,8 +/- 17,8]. Advanced age, delay of hospitalisation, severity of the disease at admission and hypoglucorrachia are the major prognosis factors of mortality intensive care unit