Adverse prognostic risk factors for pneumococcal meningitis in children

Abstract

Objective To explore the risk factors for childhood death from pneumococcal meningitis. Methods The data of 32 hospitalized children were retrospectively analyzed, who were diagnosed as pneumococcal meningitis and enrolled in the Affiliated Children′s Hospital of Soochow University from November 2010 to December 2015.The subjects were divided into the death group and survival group according to their prognosis.The clinical characteristics and laboratory data were compared between 2 groups. Results Between the death group and survival group, there were significant statistically differences in shock within 24 hours after admission(63.6% vs 14.3%, P=0.013), as well as endotracheal tube intubation(100.0% vs 23.8%, P<0.001), the levels of cerebrospinal fluid(CSF) IgG[(491.27±203.53) mg/L vs (267.24±188.07) mg/L, P=0.006], IgM[(115.72±79.19) mg/L vs (32.80±28.52) mg/L, P=0.006], IgA[59.52(15.51, 75.69) mg/L vs 18.77(9.33, 27.54) mg/L, P=0.023], CSF leukocyte[330.00(150.00, 380.00)×106/L vs 870.00(403.00, 6 160.00)×106/L, P=0.009], CSF protein[(4 047.00±1 942.16) mg/L vs (2 470.62±1 259.94) mg/L, P=0.009], CSF adenosine deaminase (ADA)[35.20(18.90, 87.20) U/L vs 8.80(3.05, 23.78) U/L, P=0.001], serum sodium[(130.21±2.85) mmol/L vs (132.83±3.69) mmol/L, P=0.049], serum lactic acid (LA)[4.40(2.60, 5.70) mmol/L vs 2.40(1.75, 4.50) mmol/L, P=0.013], serum C-reactive protein (CRP)[(95.87±65.40) mg/L vs (165.61±83.05) mg/L, P=0.022], serum lactate dehydrogenase (LDH)[813.40(465.20, 2 310.70) U/L vs 359.20(257.85, 405.90) U/L, P=0.001], platelet[(163.82±164.86)×109/L vs (295.71±130.29)×109/L, P=0.019] and positive rate of blood culture(90.9% vs 47.6%, P=0.023) between the death group and survival group. Conclusions The risk factors associated with mortality in pediatric SPM include shock within 24 hours after admission, endotracheal intubation, hyponatremia, thrombocytopenia, as well as high serum LA level, high serum LDH level, lower serum CRP level or cultures of blood and CSF double positive. Key words: Meningitis; Mortality; Prognosis; Streptococcus pneumoniae; Child