Faculty of Health Sciences, University Diego Portales, Santiago, Chile.
Pediatr Infect Dis J. 2010 Feb;29(2):122-5. doi: 10.1097/INF.0b013e3181b6e7d3.
Malnutrition may be an important cofactor explaining poor outcome of childhood bacterial meningitis (BM) in developing countries. We examined its effect in Latin American children.
The weight-for-age z score was determined for 482 children with BM aged 2 months to 5 years. Normal weight (z score from >-1 to <+1), underweight (z score <-1) and overweight (z score >+1) children were compared on admission, in-hospital and at discharge. Using uni- and multivariate analysis, we sought for associations between malnutrition and 3 different outcomes.
The mean z score was -0.41 +/- 1.54, with a normal distribution. Overall, 260 (54%) patients were of normal weight, 151 (31%) underweight, and 71 (15%) overweight. Compared with others, underweight patients had on admission a lower Glasgow coma score (P = 0.0006) and cerebrospinal fluid glucose concentration (P = 0.03), and a slower capillary filling time (P = 0.02). Their death rate was higher (P = 0.0004) and they survived with more neurological sequelae (P = 0.04), but a similar frequency of hearing impairment (P > 0.05). The odds for death increased 1.98 times by mild (95% confidence interval [CI], 1.03-3.83; P = 0.04), 2.55 times by moderate (95% CI, 1.05-6.17; P = 0.04), and 5.85 times (95% CI, 2.53-13.50; P < 0.0001) by severe underweight. Overweight was not associated with adverse outcomes (P > 0.05).
Children who are underweight at the time of onset of BM have a substantially increased probability of neurological sequelae and death.
营养不良可能是发展中国家儿童细菌性脑膜炎（BM）不良预后的一个重要的合并因素。我们研究了其在拉丁美洲儿童中的作用。
对 482 名 2 个月至 5 岁的细菌性脑膜炎患儿进行体重与年龄的 Z 评分。正常体重（Z 评分>-1 至<+1）、体重不足（Z 评分<-1）和超重（Z 评分>+1）患儿入院时、住院期间和出院时进行比较。采用单变量和多变量分析，我们寻找营养不良与 3 种不同结局之间的关系。
平均 Z 评分为-0.41 +/- 1.54，呈正态分布。总体而言，260 例（54%）患儿为正常体重，151 例（31%）为体重不足，71 例（15%）为超重。与其他患儿相比，体重不足患儿入院时格拉斯哥昏迷评分较低（P = 0.0006），脑脊液葡萄糖浓度较低（P = 0.03），毛细血管充盈时间较慢（P = 0.02）。其死亡率较高（P = 0.0004），且存活患儿的神经系统后遗症较多（P = 0.04），但听力障碍的发生率相似（P>0.05）。轻度（95%可信区间[CI]，1.03-3.83；P = 0.04）、中度（95%CI，1.05-6.17；P = 0.04）和重度（95%CI，2.53-13.50；P<0.0001）体重不足患儿的死亡风险分别增加 1.98 倍、2.55 倍和 5.85 倍。超重与不良预后无关（P>0.05）。
在细菌性脑膜炎发病时体重不足的患儿发生神经系统后遗症和死亡的可能性显著增加。
