Clinical, biochemical and microbiological factors associated with the prognosis of pneumococcal meningitis in children / Factores clínicos, bioquímicos y microbiológicos relacionados con el pronóstico de la meningitis neumocócica en niños

BACKGROUND: Pneumococcal 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. METHODS: Prospective 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. RESULTS: A 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). CONCLUSIONS: Patients 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

INTRODUCCIÓN: Las meningitis neumocócicas (MN) se relacionan con una elevada morbimortalidad. El objetivo del estudio es evaluar qué factores se relacionan con un peor pronóstico. MÉTODOS: Estudio 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. RESULTADOS: Se 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). CONCLUSIONES: Los menores de 2 años con mayor depresión del sensorio al ingreso, especialmente cuando requieren soporte ventilatorio prolongado, tienen un mayor riesgo de mala evolución

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

BACKGROUND: Pneumococcal 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. METHODS: Prospective 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. RESULTS: A 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). CONCLUSIONS: Patients 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.

Relative Adrenal Insufficiency in Pediatric Septic Shock.

Sepsis and septic shock represent important causes of morbidity and mortality in children, and adrenal dysfunction may play a role in the cardiovascular and immunological response. According to existing reports, the incidence of adrenal dysfunction in critically ill children varies significantly between 4 and 52% of patients. This article reviews the concept of adrenal insufficiency and the role it may play in a pediatric septic shock. Also discussed are the diagnosis, prognosis, and treatment of adrenal insufficiency in septic shock in adults and children. Finally, the latest recommendations about steroid use in pediatric septic shock are summarized.

Prognostic factors in pediatric sepsis study, from the Spanish Society of Pediatric Intensive Care.

BACKGROUND: Sepsis and septic shock represent up to 30% of admitted patients in pediatric intensive care units, with a mortality that can exceed 10%. The objective of this study is to determine the prognostic factors for mortality in sepsis. METHODS: Multicenter prospective descriptive study with patients (aged 7 days to 18 years) admitted to the pediatric intensive care units for sepsis, between January 2011 and April 2012. RESULTS: Data from 136 patients were collected. Eighty-seven were male (63.9%). The median age was a year and a half (P25-75 0.3-5.5 years). In 41 cases (30.1%), there were underlying diseases. The most common etiology was Neisseria meningitidis (31 cases, 22.8%) followed by Streptococcus pneumoniae (16 patients, 11.8%). Seventeen cases were fatal (12.5%). In the statistical analysis, the factors associated with mortality were nosocomial infection (P = 0.004), hypotension (P <0.001) and heart and kidney failure (P < 0.001 and P = 0.004, respectively). The numbers of leukocytes, neutrophils and platelets on admission were statistically lower in the group that died (P was 0.006, 0.013 and <0.001, respectively). Multivariate analysis showed that multiple organ failure, neutropenia, purpura or coagulopathy and nosocomial infection were independent risk factors for increased mortality (odds ratio: 17, 4.9, 9 and 9.2, respectively). CONCLUSIONS: Patients with sepsis and multiorgan failure, especially those with nosocomial infection or the presence of neutropenia or purpura, have a worse prognosis and should be monitored and treated early.