title: Acute bacterial meningitis in the intensive care unit and risk factors for adverse clinical outcomes: retrospective study.
abstract: BACKGROUND
  Bacterial meningitis constitutes a medical emergency. Its burden has driven from childhood to the elderly and the immunocompromised population. However, the admission of patients with bacterial meningitis to the intensive care unit (ICU) has been sparsely approached, as have the prognostic factors associated with an adverse clinical outcome.
  
  
  METHODS
  We performed a retrospective analysis during a 7-year period of patients older than 18 years admitted to 2 polyvalent ICUs. Clinical, demographic, and outcome data were collected to evaluate its clinical impact on the outcome of patients with acute bacterial meningitis.
  
  
  RESULTS
  We identified 65 patients with the diagnosis of acute bacterial meningitis (mean Acute Physiology and Chronic Health Evaluation II, 23; hospital mortality, 40%). Upon clinical presentation, their most frequent signs were fever (84%), seizures (21.5%), and a low Glasgow Coma Scale (GCS) score (GCS<8; 58.4%). Fifty-five patients (85%) required organ support. A definite microbiological diagnosis was achieved in 45 patients. An adverse clinical outcome was noted in 46 patients (71%). These patients were older (P=.005), had higher Physiology and Chronic Health Evaluation II score (P=.022), and had lower GCS (P=.022). In the multivariate analysis, older age (per year; adjusted odds ratio [aOR], 1.059) was associated with an adverse outcome, whereas a higher GCS (per point; aOR, 0.826) and presence of fever upon admission (aOR, 0.142) increase the chance of a good recovery.
  
  
  CONCLUSIONS
  Patients with acute bacterial meningitis admitted to ICU had substantial morbidity and mortality. Those with low GCS or absence of fever have a particularly high risk of an adverse outcome.
authors.affiliation: Infectious Disease and Tropical Medicine Department, Egas Moniz Hospital, CHLO, Lisbon, Portugal; Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal. Electronic address: dianacatarinafernandes@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Fernandes
authors.affiliation: Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal. Electronic address: joaogpster@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Gonçalves-Pereira
authors.affiliation: Internal Medicine Department, Hospital de São Bernardo, CHS, Lisbon, Portugal. Electronic address: sergiojaneiro@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Janeiro
authors.affiliation: Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal. Electronic address: joanapsilvestre@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Silvestre
authors.affiliation: Medical Emergency Unit, São José Hospital, CHLC, Lisbon, Portugal. Electronic address: luisfilipenunesbento@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Bento
authors.affiliation: Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal; Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal. Electronic address: povoap@netcabo.pt.
authors.forename: P
authors.initials: P
authors.lastname: Póvoa
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005334:Fever / Q000209:etiology; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Bacterial meningitis; Critically ill; Outcome; Severe sepsis