Coagulation, coma, and outcome in bacterial meningitis--an observational study of 38 adult cases.
OBJECTIVE
The purpose of this study was to evaluate the epidemiology of intravascular coagulation in bacterial meningitis and to recognise the associations with disease severity and outcome.


METHODS
Thirty-eight consecutively admitted adult patients with microbiologically proven bacterial meningitis were observed prospectively for platelets count (PLT), platelets-decline (dPLT), prothrombin ratio (PTr), INR, and D-dimer levels during the first three days in relation to disease severity (Glasgow Coma Scale--GCS, APACHE-III) and outcome (Glasgow Outcome Scale--GOS).


RESULTS
The prevalence of activated coagulation measured by abnormal laboratory results varied respectively: PTr--30%, INR--36%, PLT--38%, dPLT--50%, and D-dimer--88%. Patients with GCS <9 at admission presented with laboratory results suggesting triggered coagulation: dPLT 48 vs. 15%/day (p=0.0246), INR 1.6 vs. 1.12 (p=0.0014), PTr 76 vs. 93% (p=0.0020). An unfavourable outcome (GOS 1-4) was observed in 42% of patients and was associated with: PLT <170 or >265 G/L (OR--24.4; p=0.0006), PTr <82% (OR--5.00; p=0.0388), INR >1.1 (OR--5.04; 0.0336), and D-dimer >850 ng/ml (OR--24.0; p=0.0033).


CONCLUSIONS
Coagulation was activated in a majority of patients with bacterial meningitis and related to coma and unfavourable outcome.
Kowalik
Maciej Michał
MM
Department of Anaesthesiology and Intensive Therapy, Medical University of Gdańsk, ul. Debinki 7, 80-211 Gdańsk, Poland. mkowalik@amg.gda.pl
Smiatacz
Tomasz
T
Hlebowicz
Maria
M
Pajuro
Robert
R
Trocha
Hanna
H
D018806:APACHE; D058186:Acute Kidney Injury / Q000150:complications; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003128:Coma / Q000145:classification / Q000150:complications*; D004211:Disseminated Intravascular Coagulation / Q000150:complications*; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008875:Middle Aged
D000900:Anti-Bacterial Agents