ISSN 1683-9803 versión on-line
Introduction: Streptococcus pneumonaie (Spn) is now the leading cause of bacterial meningitis in Paraguay, and is accompanied by high mortality (20%-40%) in spite of the use of appropriate antibiotic therapy and the availability of an ICU. Objective: To develop a prognostic scale for mortality in children with pneumococcal meningitis (PM), which could be applied upon hospitalization and guide therapeutic management toward more aggressive treatment and more timely admission to intensive care. Materials and Methods: We performed an observational, retrospective study at the Pediatric Department of the Institute of Tropical Medicine that included all patients (pts) age <16 admitted between 2000 and 2010 with a laboratory-confirmed diagnosis of meningitis due to Streptococcus pneumonaie. Confirmation consisted of isolation of the organism in CSF and/or blood culture. The variables analyzed were grouped into clinical and laboratory variables. We identified the risk factors that were significant for mortality. After identifying the factors associated with mortality, we constructed a scale that assigned from 0 to 3 points to each variable according to their respective degrees of significance. Results: During the study period 49 pts with PM were hospitalized, with 46 being evaluable using complete records, of whom 19/46 (38%) died and 27/46 (58%) survived. Symptoms appeared in <48 hours in 8 of the 19 pts who died vs. 17 of the 26 survivors (p=0.1), with a tendency seen toward increased frequency of seizures at admission or within 48 hours in those who died 15/18 (83%) vs. 17/26 (65%) of survivors. Of those who died, 6/18 (33%) vs 2/26 pts (7%) were admitted with a Glasgow Score of ≤ 10 points (p=0.03), with Hb levels ≤ 7mg/dl in the 5/18 pts (28%) who died vs. 0/26 who survived (p=0.04). Other risk factors for mortality included hypoglycorrhachia <20 mg/dl (94% vs. 46%, p<0.005), CSF albumin ≥250 mg/dl (61% vs. 30%, p=0.04), and pleocytosis ≤200/mm3 (50% vs. 23%, p=0.06). No difference was found in age ≤6 months, malnutrition, or presence of bacteremia between groups. The mortality risk scale using hypoglycorrhachia <20 mg/dl, Hb ≤7 g/dl, Glasgow Score <10, CSF albumin ≥250 mg/dl and pleocytosis ≤200/mm3 correlated significantly with mortality (p<0.001). Conclusions: It was possible to identify pts with PM who had risk factors associated with mortality at the time of admission. A scale of mortality based on the presence of risk factors could provide a valuable and easily applied tool to establish the risk of severity and prognosis for pneumococcal meningitis at the time of admission.
Palabras claves: Pneumococcal meningitis; prognostic scale; scale of mortality.
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