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Chronic alcohol abuse affects the clinical course and outcome of community-acquired bacterial meningitis
Marcin Paciorek1, Agnieszka Bednarska2, Dominika Krogulec2
1Department of Adult Infectious Diseases, Medical University of Warsaw, Warsaw, Poland. mpaciorek@op.pl.
Abstract:
The aim of the study was to determine the effect of chronic alcohol abuse on the course and outcome of bacterial meningitis (BM). We analyzed records of patients with BM who were hospitalized between January 2010 and December 2017 in the largest neuroinfection center in Poland. Out of 340 analyzed patients, 45 (13.2%) were alcoholics. Compared with non-alcoholics, alcoholics were more likely to present with seizures (p < 0.001), scored higher on the Sequential Organ Failure Assessment (SOFA) (p = 0.002) and lower on the Glasgow Coma Scale (GCS) (p < 0.001), and had worse outcome as measured by the Glasgow Outcome Score (GOS) (p < 0.001). Furthermore, alcoholics were less likely to complain of headache (p < 0.001) and nausea/vomiting (p = 0.005) and had lower concentration of glucose in cerebrospinal fluid (CSF) (p = 0.025). In the multiple logistic regression analysis, alcoholism was associated with lower GCS (p = 0.036), presence of seizures (p = 0.041), male gender (p = 0.042), and absence of nausea/vomiting (p = 0.040). Furthermore, alcoholism (p = 0.031), lower GCS score (p = 0.001), and higher blood urea concentration (p = 0.018) were independently associated with worse outcome measured by GOS. Compared with non-alcoholics, chronic alcohol abusers are more likely to present with seizures, altered mental status, and higher SOFA score and have an increased risk of unfavorable outcome. In multivariate analysis, seizures and low GCS were independently associated with alcoholism, while alcoholism was independently associated with worse outcome.
Insights
Chronic alcohol abuse significantly worsens bacterial meningitis outcomes. Alcoholics present with more seizures and altered mental status, leading to a higher risk of unfavorable results and death.
Area of Science:
- Neurology
- Infectious Diseases
- Toxicology
Background:
- Bacterial meningitis (BM) is a severe infection with significant morbidity and mortality.
- Chronic alcohol abuse is a prevalent condition that may impact infectious disease outcomes.
- The specific effects of alcoholism on the course and prognosis of BM require further elucidation.
Purpose of the Study:
- To investigate the impact of chronic alcohol abuse on the clinical presentation, disease course, and outcomes of bacterial meningitis.
- To identify specific clinical and laboratory features associated with alcoholism in BM patients.
- To determine if alcoholism is an independent risk factor for poor outcomes in bacterial meningitis.
Main Methods:
- Retrospective analysis of bacterial meningitis (BM) patient records from a major neuroinfection center in Poland (2010-2017).
- Comparison of clinical characteristics, laboratory findings, and outcomes between alcoholic and non-alcoholic BM patients.
- Statistical analysis including multiple logistic regression to identify independent predictors of outcome.
Main Results:
- Alcoholic patients (13.2%) were more likely to experience seizures, had higher Sequential Organ Failure Assessment (SOFA) scores, and lower Glasgow Coma Scale (GCS) scores.
- Alcoholics reported less headache and nausea/vomiting and had lower cerebrospinal fluid (CSF) glucose concentrations.
- Alcoholism was independently associated with lower GCS, presence of seizures, male gender, absence of nausea/vomiting, and worse Glasgow Outcome Score (GOS).
Conclusions:
- Chronic alcohol abuse is associated with a distinct clinical presentation in bacterial meningitis, including a higher likelihood of seizures and altered mental status.
- Alcoholism is an independent risk factor for unfavorable outcomes in bacterial meningitis, as measured by the Glasgow Outcome Score.
- These findings highlight the importance of considering alcohol abuse history in the management and prognostication of bacterial meningitis.
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