Prognostic Score of Leclerc et al in Pediatric Meningococcemia

 

Patient population:

(1) pediatric patients with infectious purpura, septicemia and sometimes shock, usually but not proven to be due to Neisseria meningitidis infection

(2) prospective study sent to pediatric intensive care units in France

 

Factors associated with increased mortality in meningococcemia:

(1) shock

(2) coma

(3) ecchymotic or necrotic purpura

(4) temperature < 36°C

(5) absence of meningism

(6) WBC count < 10,000 per µL

(7) platelet count < 100,000 per µL

(8) fibrinogen < 150 mg/dL

(9) potassium > 5.0 mEq/L

(10) CSF WBC count < 20 per µL

 

Since shock was one of the main prognostic factors in meningococcemia (42% of patients in shock die, vs 6% of those not in shock), a prognostic score was developed for children in shock based on the following parameters:

(1) age

(2) potassium

(3) WBC count in blood

(4) clinical signs of meningism

(5) platelet count

Parameters	Finding	Points
age	< 1 year	1
	1-2 years	2
	> 2 years	3
potassium	<= 5 mEq/L	0
	> 5 mEq/L	1
WBC count	>= 10,000	0
	< 10,000	1
clinical meningism	absent	0
	present	1
platelet count	>= 100,000 per µL	0
	< 100,000 per µL	1

 

prognostic score for children in shock =

= (1.7 * (potassium)) - (age) + (0.7 * (WBC)) - (1.3 * (meningism)) + (platelets) + 1.9

 

Interpretation

 

88% with scores < -1 survived

75% with scores < 0 survived

39% with scores > 0 survived

24% with scores > 1 survived

 

Score	Survival
-3	100%
-2	81-100%
-1	81-86%
0	60-67%
1	19-48%
2	0-29%
3	0%

(from data in Figures 1 and 2 page 142)