Fatal course in severe meningococcemia: clinical predictors and effect of transfusion therapy.
OBJECTIVE
To investigate whether the administration of fresh-frozen plasma to patients with systemic meningococcal disease is associated with an increased mortality rate compared with the administration of plasma substitutes.


METHODS
Seventeen-year case-control study.


METHODS
Intensive care units and departments of internal medicine and pediatrics of one university hospital and one local hospital.


METHODS
A total of 336 patients with culture-proven meningococcemia or symptoms characteristic of meningococcemia who were admitted to two hospitals in northern Norway between 1974 and 1991.


RESULTS
High-risk patients were selected on the basis of two different scoring systems (Niklasson's score and clinical score) and classified according to the type of intravenous fluid regimen (fresh-frozen plasma, blood, or colloids). For comparison between groups, analysis of variance and chi-square tests were used. Assessments of adjusted effects on mortality rate were done by multiple logistic regression. Administration of blood or plasma was significantly associated with a fatal course, both in the total patient population (p < .01) and in the high-risk group (p = .02), while using colloids alone was negatively associated with death, although not reaching statistical significance. A significantly lower mortality rate was found in one of the hospitals where colloids were used instead of plasma or blood in the last part of the period studied (p < .05).


CONCLUSIONS
The results support our hypothesis that the use of fresh-frozen plasma may negatively influence outcome in systemic meningococcal disease.
Busund
R
R
Department of Surgery, University Hospital of Tromsø, Norway.
Straume
B
B
Revhaug
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016470:Bacteremia / Q000401:mortality* / Q000628:therapy; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008589:Meningococcal Infections / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010949:Plasma; D010952:Plasma Substitutes / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
D010952:Plasma Substitutes