Risk factors for poor prognosis in children with refractory purulent meningitis and the discharge criteria

Abstract

This study was undertaken to investigate the relationship between cerebrospinal fluid abnormalities and prognosis in pediatric refractory purulent meningitis. Ninety cases of pediatric refractory purulent meningitis were stratified into "good" (n=33) or "poor" (n=57) prognosis groups according to the Glasgow clinical outcome scores. The symptoms, laboratory results, and prognosis were compared by using univariate and multivariate logistic regression analyses. Univariate analysis showed that poor prognosis was associated with: unequal pupil size in both eyes; positive Babinski sign; CSF-WBC >500×10/L, CSF protein concentration >1.0g/L, CSF glucose content <1.5mmol/L; initial procalcitonin result >0.1ng/dL on admission; hemoglobin <90g/L during hospitalization; abnormal head imaging, and abnormal electroencephalogram. On multivariate analysis only unequal pupil size in both eyes and CSF glucose content <1.5mmol/L remained significant. The CSF protein concentration was significantly different between groups at discharge. The cutoff value was 0.68g/L. We recommend that discharged patients meet the following criteria: full antibiotic course and over 1 week of defervesce, disappearance of acute phase symptoms, CSF-WBC ≤28×10/L, CSF glucose >1.75mmol/L, and protein <0.68g/L. The patient may be discharged for follow-up if no relapse occurs during 3-5 days of observation after drug withdrawal.

Kliniğimizde 1992–2011 yılları arasında akut bakteriyel menenjit tanısıyla yatarak tedavi gören hastalarda erken komplikasyonlarla ilişkili etmenler

“…The development of complications was found with a higher frequency in patients with a CSF glucose levels below 45 mg/dL, as in our study, and this level was shown to be associated with hearing loss ( 8 , 10 , 19 , 20 , 25 ). Some studies reported that increased CSF protein levels were among poor prognostic factors ( 10 , 19 , 20 , 25 ), we found no significant difference.…”

“…In some studies, leukopenia or reduced hemoglobin levels (<9 g/dL) were among poor prognostic factors. In our study, however, the presence of leukocytosis was associated with the development of complications ( 10 , 19 , 20 , 25 ). The development of complications was found with a higher frequency in patients with a CSF glucose levels below 45 mg/dL, as in our study, and this level was shown to be associated with hearing loss ( 8 , 10 , 19 , 20 , 25 ).…”

“…In a meta-analysis including 31 studies, it was found that male sex was a significant risk factor in determining prognosis (mortality and neurological sequela) in ABM ( 19 ). In some studies, however, it was shown that sex had no influence on prognosis ( 5 , 7 – 9 , 11 , 20 ).…”

“…This was followed by rash with a rate of 15.4%, restlessness (11.8%), seizure (11%), malaise (9.3%), loss of appetite-absence of suckling (8%), diarrhea (4.1%), symptoms of upper respiratory tract infection (URTI) (4.6%), neck pain (2.3%), and diplopia (1%). Generally, studies have reported the following rates for the signs and symptoms: fever, 90.9–97.8%; vomiting, 59.8–82.6%; headache, 38.6–6.9%; seizure 20–64.9%; diarrhea, 4.5%; rash, 2.3–41.2%, restlessness, 2.3–92.9%, and change in consciousness, 10.2–40.9% ( 4 , 5 , 7 , 8 , 10 , 20 ). Although studies have found change in consciousness, coma, seizure, anisochoria, positive Babinski reflex, disrupted peripheral circulation, severe respiratory distress, petechia, and fever lasting longer than seven days to be poor prognostic factors, we found that restlessness and rash to be significant poor prognostic factors in our study ( 5 , 8 – 10 , 15 , 19 , 20 , 23 – 25 ).…”

Risk Factors for Hydrocephalus in Neonatal Purulent Meningitis: A Single-Center Retrospective Analysis

“…Alterations in cerebrospinal fluid parameters have been identified as predictors of severe neurologic complications, including hydrocephalus. 2,14 -18 Cerebrospinal fluid glucose <2 mmol/L was identified as a risk factor for hydrocephalus in our study. However, Huo et al 2 did not reach the same conclusion in the study of children under 14 years old, which may be related to the higher cerebrospinal fluid glucose level in newborns than that in older children.…”