title: Coagulation, coma, and outcome in bacterial meningitis--an observational study of 38 adult cases.
abstract: 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.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Medical University of Gdańsk, ul. Debinki 7, 80-211 Gdańsk, Poland. mkowalik@amg.gda.pl
authors.forename: Maciej Michał
authors.initials: MM
authors.lastname: Kowalik
authors.forename: Tomasz
authors.initials: T
authors.lastname: Smiatacz
authors.forename: Maria
authors.initials: M
authors.lastname: Hlebowicz
authors.forename: Robert
authors.initials: R
authors.lastname: Pajuro
authors.forename: Hanna
authors.initials: H
authors.lastname: Trocha
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents