Predictors of Outcome in Children With Acute Meningococcal Infection

Algren, John T.; Cutliff, Sue

doi:10.1097/00006565-198812000-00028

Cited by 9 publications

(22 citation statements)

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“…Complex laboratory determinations (such as laboratory assessment of the coagulation system) were not included in the definition of NESI in order to have the score evaluable at any time. In our patients, two important points contributed mainly to the lower sensitivity and specificity of the criteria proposed by Algren et al [2]: (1) the metabolic state was not considered, and (2) prolonged capillary filling time may in some patients occur despite an otherwise good prognosis.…”

Section: Discussionmentioning

confidence: 81%

“…The combination of the parameters circulatory insufficiency, coagulopathy and white blood cell count < 10,000/btl was used by Algren et al [2] to predict multi organ failure and death in paediatric meningococcal disease. Some of these parameters (subcutaneous bleeding, increased heart rate and decreased MAP) were included in the NESI.…”

Section: Discussionmentioning

confidence: 99%

“…When applied to the patients of this study (see Table 3), GMSPS was >8 in two out of four patients with fatal outcome and in 2/13 survivors (sensitvity 50%; specificity 85%; predictive value positive 50%). The prognostic criteria by Algren et al ( [2], Table 3) predicted death in three out of four patients with fatal outcome but -falsely -in 2/13 survivors (sensitvity 75%; specificity 85%; predictive value positive 60%).…”

Section: Comparison Of Tcc Tnf(z and Nesimentioning

confidence: 99%

“…Algren et al [2] reported that the combination of the three parameters: (1) circulatory insufficiency (i.e. capillary filling time > 3 s, or systolic blood pressure < 70 mm Hg or < 5th percentile for the respective age group), (2) white blood cell count < 10,000/gl and (3) coagulopathy (i.e.…”

Section: Calculation Of Other Scores For Severity Of Meningococcal Inmentioning

confidence: 99%

“…The clinical manifestations of sepsis should and have been graded in the past [2,15] because decisions on monitoring and on therapy depend on the severity of the disorder, especially in a potentially peracute course of the disease. We devised a new score (named: Neisseria sepsis index [NESI]), that includes parameters of cardiovascular and metabolic derangement and the symptoms of subcutaneous bleeding and/or skin necrosis.…”

Section: Introductionmentioning

confidence: 99%

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Definition of a new score for severity of generalizedNeisseria meningitidis infection

et al. 1995

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Neisseria meningitidis infection may present as meningitis or as severe, fulminant sepsis. In order to classify individual patients early according to the expected course of the disease, we developed a score named Neisseria sepsis index [NESI]. The NESI was defined using the parameters heart rate, mean arterial blood pressure, base excess and presence of acute subcutaneous bleeding and/or skin necroses (minimal value [= no evidence for sepsis] NESI 0; maximum value [= most severe sepsis] NESI 8). Seventeen patients with documented, systemic N. meningitidis infection were prospectively assessed for the terminal complement complex (TCC), serum tumour necrosis factor alpha (TNF alpha) levels (as laboratory parameters for severity of sepsis) and NESI score. The evaluation was immediately performed when the patients were admitted to the hospital. The 17 patients showed the following distribution of data: NESI 0 (n = 4), NESI 1 (n = 6), NESI 2 (n = 0), NESI 3 (n = 1), NESI 4 (n = 2), NESI 5 (n = 2), NESI 6 (n = 0), NESI 7 (n = 1), NESI 8 (n = 1). Mortality was 4/17 patients, all had NESI > or = 5. TCC values ranged from 647-6461 ng/ml (normal range: 130-360 ng/ml); and was not correlated to NESI. TNF alpha values ranged from 10-910 pg/ml and were correlated to NESI (r2 = 0.71, n = 17, P < 0.001). In patients with fatal outcome, TNF alpha was 600 +/- 160 pg/ml (mean +/- SEM) and in surviving patients 130 +/- 50 pg/ml (mean +/- SEM). TNF alpha was increased in 15/17 patients when compared to normal controls (< 27 pg/ml). CONCLUSION. The NESI is based on few clinical, objective data, that are available in every hospital. NESI appears to offer an instrument: (1) for making decisions in regard to appropriate monitoring and treatment of vital organ function; and (2) for assessing the quality of care for this life-threatening infection.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Comparison Of Tcc Tnf(z and Nesimentioning

confidence: 99%

Section: Calculation Of Other Scores For Severity Of Meningococcal Inmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Definition of a new score for severity of generalizedNeisseria meningitidis infection

et al. 1995

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A normal platelet count at admission in acute meningococcal disease does not exclude a fulminant course

et al. 1998

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Prospective validation of the Glasgow Meningococcal Septicaemia Prognostic Score. Comparison with other scoring methods

et al. 2002

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the Glasgow Meningococcal Septicaemia Prognostic Score is an easily performed, repeatable, clinical score that can rapidly identify children with fulminant meningococcal disease. When performed prospectively, a score > or =8 had a positive predictive value for death of 29%. This score can identify those children who should be offered intensive care and can select those who may benefit from novel therapies.

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Predictors of Outcome in Children With Acute Meningococcal Infection

Cited by 9 publications

References 0 publications

Definition of a new score for severity of generalizedNeisseria meningitidis infection

Definition of a new score for severity of generalizedNeisseria meningitidis infection

A normal platelet count at admission in acute meningococcal disease does not exclude a fulminant course

Prospective validation of the Glasgow Meningococcal Septicaemia Prognostic Score. Comparison with other scoring methods

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