Makowiecki Michał, Paciorek Marcin, Bednarska Agnieszka, Krogulec Dominika, Porowski Dawid, Bursa Dominik, Skrzat-Klapaczyńska Agata, Bieńkowski Carlo, Kowalska Justyna D, Zielenkiewicz Magdalena, Horban Andrzej, Laskus Tomasz
Department of Adults' Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
Institute of Mathematics, University of Warsaw, 02-097 Warsaw, Poland.
J Clin Med. 2024 Dec 23;13(24):7845. doi: 10.3390/jcm13247845.
: The aim of this study was to evaluate the association between various clinical and laboratory findings and in-hospital mortality in community-acquired bacterial meningitis (BM). : We retrospectively analyzed 339 adult (≥18 years old) patients with bacterial meningitis who were admitted to the Hospital for Infectious Diseases in Warsaw between January 2010 and December 2017. : Altogether, 56 patients (16.5%) died during hospitalization. On admission, the non-survivors scored lower on the Glasgow Coma Scale (GCS) (median 7 vs. 13, < 0.001) and higher on the Sequential Organ Failure Assessment (SOFA) score (median 6 vs. 2, < 0.001) and were less likely to complain about headaches (18.75% vs. 54.21%, < 0.001) and nausea and/or vomiting (1.89% vs. 36.2%, < 0.001), but were more likely to manifest peripheral nerve palsies (21.43% vs. 9.61%, = 0.02). The patients who died were also more likely to be immunocompromised (53.57% vs. 34.28%, = 0.01), have etiology (35.71% vs. 16.25%, = 0.001), higher concentrations of procalcitonin (median 5.035 ng/mL vs. 2.245 ng/mL, = 0.003) and urea (median 10.7 mmol/L vs. 5.865 mmol/L, < 0.001) in the blood and higher protein (median 4.57 g/L vs. 2.605 g/L, = 0.014) and lower glucose levels (median 0.765 mmol/L vs. 1.89 mmol/L, = 0.006) in the cerebrospinal fluid (CSF). In a multiple logistic regression analysis, which was conducted separately for the GCS and SOFA, both scoring systems (OR = 0.67, OR 95% CI 0.59-0.75, < 0.001 for GCS and OR = 1.42, OR 95% CI 1.29-1.60, < 0.001 for SOFA) as well as an age over 70 years (OR = 3.99, OR 95% CI 1.39-12.93, = 0.014) and etiology (OR = 2.38, OR 95% CI 1.12-4.99, = 0.022) were associated with in-hospital deaths. : The survivors and non-survivors with BM differed with respect to a number of signs and symptoms, etiology, the results of blood and CSF laboratory tests, and the immune deficiency status, as well as the GCS and SOFA scores. In the multiple logistic regression analysis, both of the GCS and SOFA scoring systems, age and etiology showed high associations with the in-hospital deaths.
本研究的目的是评估社区获得性细菌性脑膜炎（BM）的各种临床和实验室检查结果与住院死亡率之间的关联。我们回顾性分析了2010年1月至2017年12月期间在华沙传染病医院住院的339例成年（≥18岁）细菌性脑膜炎患者。共有56例患者（16.5%）在住院期间死亡。入院时，非幸存者的格拉斯哥昏迷量表（GCS）评分较低（中位数7 vs. 13，<0.001），序贯器官衰竭评估（SOFA）评分较高（中位数6 vs. 2，<0.001），头痛主诉较少（18.75% vs. 54.21%，<0.001），恶心和/或呕吐较少（1.89% vs. 36.2%，<0.001），但更易出现周围神经麻痹（21.43% vs. 9.61%，=0.02）。死亡患者也更易出现免疫功能低下（53.57% vs. 34.28%，=0.01），有[具体病因未明确写出]病因（35.71% vs. 16.25%，=0.001），血液中降钙素原浓度较高（中位数5.035 ng/mL vs. 2.245 ng/mL，=0.003）和尿素浓度较高（中位数10.7 mmol/L vs. 5.865 mmol/L，<0.001），脑脊液（CSF）中蛋白质较高（中位数4.57 g/L vs. 2.605 g/L，=0.014）和葡萄糖水平较低（中位数0.765 mmol/L vs. 1.89 mmol/L，=0.006）。在分别针对GCS和SOFA进行的多因素逻辑回归分析中，两种评分系统（GCS的OR = 0.67，OR 95%CI 0.59 - 0.75，<0.001；SOFA的OR = 1.42，OR 95%CI 1.29 - 1.60，<0.001）以及70岁以上年龄（OR = 3.99，OR 95%CI 1.39 - 12.93，=0.014）和[具体病因未明确写出]病因（OR = 2.38，OR 95%CI 1.12 - 4.99，=0.022）均与住院死亡相关。BM的幸存者和非幸存者在一些体征和症状、病因、血液和CSF实验室检查结果、免疫缺陷状态以及GCS和SOFA评分方面存在差异。在多因素逻辑回归分析中，GCS和SOFA评分系统、年龄以及[具体病因未明确写出]病因与住院死亡均显示出高度相关性。
