This was a case-control study to identify prognostic indicators of bacterial meningitis in a reference hospital in Pernambuco/Brazil. The data were collected from charts of 294 patients with bacterial meningitis between January 2000 and December 2004. Variables were grouped in biological, clinical, laboratory and etiologic agent/treatment. Variables selected in each step were grouped and adjusted for age. Two models were created: one containing clinical variables (clinical model) and other containing laboratory variables (laboratory model). In the clinical model the variables associated with death due to bacterial meningitis were dyspnea (p=0.006), evidence of shock (p=0.051), evidence of altered mental state (p=0.000), absence of headache (p=0.008), absence of vomiting (p=0.052), and age ≥40 years old (p=0.013). In the laboratory model, the variables associated with death due to bacterial meningitis were positive blood cultures (p=0.073) and thrombocytopenia (p=0.019). Identification of prognostic indicators soon after admission may allow early specific measures, like admission of patients with higher risk of death to Intensive Care Units.

A despeito dos enormes avanços tecnológicos quanto ao diagnóstico, compreensão da sua patogênese e seu tratamento, a meningite bacteriana (MB) ainda permanece como importante doença de distribuição mundial, sendo também endêmica no Brasil ABSTRACTThere is controversy regarding indications for cerebrospinal fluid control tests on patients who have clinically recovered from bacterial meningitis, as a cure criterion. Some authors advocate discharge after confirmation of clinical and cerebrospinal fluid normalization, while others maintain that cerebrospinal fluid analysis is not justified in all cases. This case series with group comparisons investigated changes seen in cerebrospinal fluid control tests and evaluated the importance of this for the discharge decision. Out of 297 patients studied, the cerebrospinal fluid control test did not change the discharge intention in 89.9% of the cases (healed cerebrospinal fluid), while in 10.1%, the discharge was suspended (non-healed cerebrospinal fluid). Of these, the antibiotic scheme was changed in 30%. Among the variables that might predict the presence of non-healed cerebrospinal fluid on admission, cerebrospinal fluid protein levels higher than 100mg/dl (p = 0.04) and glycorrhachia lower than or equal to 20 mg/dl (p = 0.03) were associated with a 2.5-times greater chance. These may be useful as criteria for indicating cerebrospinal fluid control tests before discharge.Key-words: Bacterial meningitis. Cerebrospinal fluid. Cerebrospinal fluid protein levels. Glycorrhachia.por pneumococos resistentes à penicilina e cefalosporina, que receberam terapia com dexametasona e vancomicina 13. Contudo, há dúvidas sobre a indicação do exame do liquor de controle em todos os pacientes, após o tempo estimado de antibioticoterapia e estando já recuperados clinicamente da MB, como critério de alta hospitalar. Alguns autores defendem que a alta hospitalar só deve ser dada após a normalização do quadro clínico e liquórico 1 6 11 . Outros consideram que o critério para alta é fundamentalmente clínico e o exame de controle, como rotina, não é justificável em todos os pacientes 7 8 9 13 . Atualmente, no Hospital Correia