Meningococcal septic shock in children: clinical and laboratory features, outcome, and development of a prognostic score.
The clinical characteristics of and outcome for 75 children with meningococcal septic shock were studied. In addition, a new prognostic scoring system was developed. The median age of the patients was 3.2 years (range, 3 weeks to 17.9 years). The most common phenotype of Neisseria meningitidis was B:4:P1.4 (27%). A mortality rate of 21% was observed. Ten (17%) of the 59 survivors had serious sequelae. Calcium levels were significantly lower in patients with seizures. Disseminated intravascular coagulation occurred in 58% of the patients who were tested. Logistic regression analysis identified four laboratory features independently associated with mortality: serum C-reactive protein level, base excess, serum potassium level, and platelet count. These features were used to develop a novel scoring system with a predictive value for death and survival of 71% and 90%, respectively. The outcome was predicted correctly for 86% of the patients, which is higher than rates previously reported for scoring systems.
Kornelisse
R F
RF
Department of Pediatrics, Sophia Children's Hospital, Erasmus University, Rotterdam, the Netherlands.
Hazelzet
J A
JA
Hop
W C
WC
Spanjaard
L
L
Suur
M H
MH
van der Voort
E
E
de Groot
R
R
D000293:Adolescent; D000471:Alkalosis / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008589:Meningococcal Infections / Q000097:blood* / Q000150:complications / Q000401:mortality; D009345:Neisseria meningitidis / Q000145:classification; D009426:Netherlands / Q000453:epidemiology; D010976:Platelet Count; D011188:Potassium / Q000097:blood; D011379:Prognosis; D012772:Shock, Septic / Q000097:blood* / Q000150:complications / Q000401:mortality
D002097:C-Reactive Protein; D011188:Potassium