Prognostic factors in meningococcal disease. Development of a bedside predictive model and scoring system. Barcelona Meningococcal Disease Surveillance Group.
BACKGROUND
Meningococcal disease is associated with significant morbidity and mortality. Development of a prognostic model based on clinical findings may be useful for identification and management of patients with meningococcal infection.


OBJECTIVE
To construct and validate a bedside model and scoring system for prognosis in meningococcal disease.


METHODS
Prospective, population-based study.


METHODS
Twenty-four hospitals in the metropolitan area of Barcelona, Spain.


METHODS
A total of 907 patients with microbiologically proven meningococcal disease. Patients diagnosed with meningococcal disease from 1987 through 1990 were used to develop the prognostic model, and those diagnosed in 1991 and 1992 were used to validate it.


METHODS
Clinical independent prognostic factors for mortality in meningococcal disease. The association between outcome and independent prognostic factors was determined by logistic regression analysis. A scoring system was constructed and tested using receiver operating characteristic curves.


RESULTS
Among 624 patients in the derivation set, 287 (46%) were male, the mean age was 12.4 years, and 34 patients (5.4%) died. Among 283 patients in the validation set, 124 (43.8%) were male, the mean age was 12.7 years, and 17 patients (6.0%) died. In multivariate analysis, independent predictors of death were hemorrhagic diathesis (odds ratio [OR], 101; 95% confidence interval [CI], 30-333), focal neurologic signs (OR, 25; 95% CI, 7-83), and age 60 years or older (OR, 10; 95% CI, 3-34), whereas receipt of adequate antibiotic therapy prior to admission was associated with reduced likelihood of death (OR, 0.09; 95% CI, 0.02-0.4). Hemorrhagic diathesis was scored with 2 points, presence of focal neurologic signs with 1 point, age of 60 years or older with 1 point, and preadmission antibiotic therapy was scored as -1. The clinical scores of -1, 0, 1, 2, and 3 or more points were associated with a probability of death of 0%, 2.3%, 27.3%, 73.3%, and 100%, respectively.


CONCLUSIONS
Hemorrhagic diathesis, focal neurologic signs, and age of 60 years or older were independent predictors of death in meningococcal disease, whereas receipt of adequate antibiotic therapy was associated with a more favorable prognosis. The scoring system presented is simple, is based on findings readily available at the bedside, and may be useful to help guide aggressive therapy.
Barquet
N
N
CAP Gràcia, Institut Català de la Salut, Barcelona, Spain. barquet@tresnet.com
Domingo
P
P
Caylà
J A
JA
González
J
J
Rodrigo
C
C
Fernández-Viladrich
P
P
Moraga-Llop
F A
FA
Marco
F
F
Vázquez
J
J
Sáez-Nieto
J A
JA
Casal
J
J
Canela
J
J
Foz
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006474:Hemorrhagic Disorders / Q000209:etiology; D017052:Hospital Mortality; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008589:Meningococcal Infections / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
D000900:Anti-Bacterial Agents