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.