Patient selection: Adults > 18 years of age admitted to the intensive care unit (ICU) with pneumococcal meningitis.
Factors associated with increased in-hospital mortality:
(1) platelet count < 100,000 per µL (adjusted odds ratio 32.7, 95% CI 3.2-332.5)
(2) arterial pH > 7.47 (adjusted odds ratio 33.1, 95% CI 3.4-319.7)
(3) mechanical ventilation (adjusted odds ratio 48.8, 95% CI 2.6-901.5)
Factors reducing in-hospital mortality:
(1) administration of corticosteroids as high dose dexamethasone (adjusted odds ratio 0.069, 95% CI 0.005-0.981)
Factors associated with increased mortality or neurologic deficit after recovery:
(1) SAPS II score determined within 48 hours of admission to ICU
|
SAPS II Score
|
Percent with Adverse Outcome
|
|
< 30
|
37%
|
|
30 – 50
|
68%
|
|
> 50
|
85%
|
from Table 5, page 716
Management implications:
(1) Hyperventilation should be used with caution (if at all).
(2) Administration of high dose dexamethasone should be considered.
where:
• The impact of pneumococcal vaccination might be interesting to evaluate.
• Correlating the prognosis with multiple organ failure scores might be interesting.
