Risk factors for death in meningococcal disease.

Of 2.139 cases of meningococcal infections notified in France from 1985 to 1989, 10% died. The risk factors for death and for purpura fulminans (extensive purpuric rash associated with cardiovascular collapsus) were studied using multifactorial analysis. The purpura fulminans was the major risk factor for death (representing 22% of the cases and 77% of the deaths in our study). In the absence of purpura fulminans, significant risk factors for death were: serogroup A or infrequent serogroup infection, an age over 50 years, and the occurrence of a septicaemia. In the presence of purpura fulminans, significant risk factors for death were an age under one year or over 10 years, and an infection with negative cultures from blood and cerebrospinal fluid. The main risk factor for purpura fulminans was the occurrence of septicaemia. Purpura fulminans appears to be a simple and specific clinical entity reflecting the high level of endotoxin released during meningococcal septicaemia.