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.