title: Bacterial meningitis in cirrhotic patients: case series and description of the prognostic role of acute renal failure.
abstract: OBJECTIVE
  To analyze the mortality risk factors in cirrhotic patients with bacterial meningitis (BM).
  
  
  BACKGROUND
  Cirrhotic patients are susceptible to infections. Despite its high mortality rate, BM has not been extensively studied in this group of patients.
  
  
  METHODS
  BM patients diagnosed with cirrhosis, between 1987 and 2008, were studied. BM was defined as the presence of signs or symptoms of meningitis and a cerebrospinal fluid (CSF) leukocyte count >100/mm3 or the presence of bacteria in CSF.
  
  
  RESULTS
  We identified 4955 infections among 7591 cirrhotic patients; 12 (0.2%) had BM. The mean age at diagnosis was 60±16 years. Abnormal mental status (83%), fever (67%), and neck stiffness (67%) were the most frequent clinical presentations. The sensitivity of CSF culture was 75% (Streptococcus pneumoniae, 2; Staphylococcus aureus, 2; Listeria monocytogenes, 1; Group B Streptococcus, 1; Streptococcus agalactiae, 1; Streptococcus bovis, 1; and Escherichia coli, 1), and its correlation with blood culture was 78%. Five patients died. On admission, the serum creatinine level was 1.63±0.93 mg/dL. A serum creatinine level ≥1.3 mg/dL was associated with increased mortality (P=0.028). The model for end-stage liver disease score, gastrointestinal bleeding, bilirubin level >3.5 mg/dL, hepatic encephalopathy, diabetes mellitus, and results of cytology and biochemistry tests of CSF were not associated with mortality.
  
  
  CONCLUSIONS
  BM in cirrhotic patients is associated with a high mortality rate. The clinical and microbiologic features of BM in cirrhotic patients differ from those in the general population. A serum creatinine level ≥1.3 mg/dL on admission is associated with a higher risk of mortality.
authors.affiliation: Instituto de Enfermedades Digestivas y Nutricionales, Hospital General San Juan de Dios, Guatemala City, Guatemala.
authors.forename: Josué
authors.initials: J
authors.lastname: Barahona-Garrido
authors.forename: Jorge
authors.initials: J
authors.lastname: Hernández-Calleros
authors.forename: Félix I
authors.initials: FI
authors.lastname: Téllez-Avila
authors.forename: Norberto C
authors.initials: NC
authors.lastname: Chávez-Tapia
authors.forename: José M
authors.initials: JM
authors.lastname: Remes-Troche
authors.forename: Aldo
authors.initials: A
authors.lastname: Torre
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D003404:Creatinine