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Risk factors analysis for early fatality in children with acute bacterial meningitis
Y C Chang1, C C Huang, S T Wang
1Department of Pediatrics, Chang Gung Children's Hospital, Kaohsiung, Taiwan.
Abstract:
To identify the cause of early fatality and to delineate the clinical findings on admission associated with this early fatality, a retrospective study of 101 children with bacterial meningitis was performed in southern Taiwan. Risk factors for early fatality are compared between patients with and without acute death in the first 3 days after admission. The overall patient fatality is 27%. Eighty-five percent of them (23 patients) occur at an average of 16.5 hours after admission despite proper antibiotic treatment. The causes of early death are predominantly hemodynamic in 14 patients (61%) and predominantly neurologic in nine (39%). Analysis of clinical parameters available on admission indicated a significant risk of early death in patients who have tachycardia, tachypnea, hypothermia, poor skin perfusion, metabolic acidosis, leukopenia, thrombocytopenia, low cerebrospinal fluid leukocyte count, and high cerebrospinal fluid lactate level. Multivariate analysis demonstrates that metabolic acidosis, poor skin perfusion, and low cerebrospinal fluid leukocyte count are independently and significantly associated with early fatality. In conclusion, two thirds of early fatalities in children with bacterial meningitis are the result of septic shock. Close surveillance for signs of septic shock, as well as of brain herniation should be continued, especially within 3 days after antibiotic treatment.
Insights
Early fatalities in children with bacterial meningitis are often due to septic shock, despite antibiotic treatment. Key risk factors include metabolic acidosis, poor skin perfusion, and low cerebrospinal fluid leukocyte counts, necessitating close monitoring.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Bacterial meningitis remains a significant cause of mortality in children.
- Early identification of risk factors for rapid fatality is crucial for timely intervention.
Purpose of the Study:
- To determine the causes of early death in pediatric bacterial meningitis.
- To identify clinical findings on admission associated with early fatality.
Main Methods:
- Retrospective study of 101 children diagnosed with bacterial meningitis in southern Taiwan.
- Comparison of risk factors for early fatality between patients who died within 3 days of admission and survivors.
- Multivariate analysis to identify independent predictors of early death.
Main Results:
- Overall fatality rate was 27%, with 85% of deaths occurring within 3 days of admission, often due to hemodynamic (septic shock) or neurologic complications.
- Clinical signs associated with increased risk of early death included tachycardia, tachypnea, hypothermia, poor skin perfusion, metabolic acidosis, leukopenia, thrombocytopenia, low CSF leukocyte count, and high CSF lactate.
- Metabolic acidosis, poor skin perfusion, and low CSF leukocyte count were independently significant predictors of early fatality.
Conclusions:
- Two-thirds of early deaths in pediatric bacterial meningitis are attributed to septic shock.
- Close surveillance for signs of septic shock and brain herniation is critical, particularly within the first 3 days of antibiotic treatment.