[Occurrence of disseminated intravascular coagulation in purulent meningitis and influence on mortality in 118 patients].
Disseminated intravascular coagulation (DIC) is an important, but not satisfactory explained risk factor of death in purulent meningitis (PM).


OBJECTIVE
Evaluation of: 1) acute thrombocytopenia (ATP) in patients with PM, 2) dynamics in changes of peripheral blood platelet (PLT) count and serum coagulation factors, 3) correlation between acute DIC and mortality in PM.


METHODS
Analysis ofATP (platelets < or = 150 K/microL and/or decrease in PLT > or = 100 K/microL/24 hours) and prothrombin ratio, fibrinogen, d-dimmer and antithrombin III in survivors and nonsurvivors in 118 adult patients with PM. 37 further patients have been disclosed because of non-bacterial PM or chronic conditions predisposing to ATP or DIC.


METHODS
DIC defined as ATP occurred in 56 %, defined as elevated d-dimmer level in 72%. 16 (14%) patients died.


RESULTS
Mortality correlated significantly with the lowest PLT count on first 3. days (p=0,049) and with PLT decline (p=0,015). Differences in survivors/nonsurvivors were observed in: ATP on 1. day 48% vs. 75% (p<0,05), daily PLT decline 9%/day vs. 32%/day (p<0,05), prothrombin ratio 89% vs. 74% (p<0,05) and INR 1,2 vs. 1,7 (p<0,005).


CONCLUSIONS
DIC is an important risk factor in PM. Aggravated DIC do correlate significantly with higher risk of death.
Kowalik
Maciej Michał
MM
Klinika Chorób Zakaźnych, Instytut Chorób Wewnetrznych Akademia Medyczna w Gdańsku. mkowalik@amg.gda.pl
Smiatacz
Tomasz
T
Hlebowicz
Maria
M
Pajuro
Robert
R
Dziarmaga-Piasecka
Nina
N
Gesing
Marta
M
Richter-Kowalik
Barbara
B
Zaborska
Barbara
B
Trocha
Hanna
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001922:Brain Abscess / Q000097:blood / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood* / Q000453:epidemiology*; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D015996:Survival Rate; D013921:Thrombocytopenia / Q000097:blood