title: Clinical, biochemical and microbiological factors associated with the prognosis of pneumococcal meningitis in children.
abstract: BACKGROUND
  Pneumococcal meningitis (PM) has a high morbidity and mortality. The aim of the study was to evaluate what factors are related to a poor PM prognosis.
  
  
  METHODS
  Prospective observational study conducted on patients admitted to the Pediatric Intensive Care Unit in a tertiary hospital with a diagnosis of PM (January 2000 to December 2013). Clinical, biochemical and microbiological data were recorded. Variable outcome was classified into good or poor (neurological handicap or death). A multivariate logistic regression was performed based on the univariate analysis of significant data.
  
  
  RESULTS
  A total of 88 patients were included. Clinical variables statistically significant for a poor outcome were younger age (p=.008), lengthy fever (p=.016), sepsis (p=.010), lower Glasgow Score (p<.001), higher score on Pediatric Risk Mortality Score (p=0.010) and Sequential Organ Failure Assessment (SOFA) (p<.001), longer mechanical ventilation (p=.004), and inotropic support (p=.008) requirements. Statistically significant biochemical variables were higher level of C-reactive protein (p<.001) and procalcitonin (p=.014) at admission, low cerebrospinal (CSF) pleocytosis (p=.003), higher level of protein in CSF (p=.031), and severe hypoglycorrhachia (p=.002). In multivariate analysis, independent indicators of poor outcome were age less than 2 years (p=.011), high score on SOFA (p=.030), low Glasgow Score (p=.042), and severe hypoglycorrhachia (p=.009).
  
  
  CONCLUSIONS
  Patients younger than 2 years of age, with depressed consciousness at admission, especially when longer mechanical ventilation is required, are at high risk of a poor outcome.
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: ijordan@hsjdbcn.org.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Jordan
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Calzada
authors.affiliation: Pediatric Service, Hospital de Sant Joan de Déu, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Monfort
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Vila-Pérez
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Felipe
authors.affiliation: Pediatric Service, Hospital de Sant Joan de Déu, Barcelona, Spain.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Cambra
authors.affiliation: Molecular Microbiology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Muñoz-Almagro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008586:Meningitis, Pneumococcal / Q000175:diagnosis* / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology
keywords: Meningitis neumocócicas; Pediatrics; Pediatría; Pneumococcal meningitis; Prognosis; Pronóstico