Prognostic factors in acute meningococcaemia.

Abstract

SUMMARY During a meningococcal (group A) epidemic, 47 Nigerian children with acute meningococcaemia without meningitis were studied. Their mortality rate was 43 % compared with 8 % during the whole epidemic. Those presenting with coma and shock had a mortality of 93 %, but without shock or coma mortality was only 6%. Coma or shock occurring alone carried an intermediate prognosis. The outcome correlated with initial serum antigen titre, but not with the serum levels of endotoxin, cortisol, or fibrin degradation products. Chloramphenicol was as effective as penicillin. A predictor of expected mortality, based on serum antigen titre and the presence of coma or shock, may allow new forms of treatment to be assessed.

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

“…As estimated from 24 patients who died in the ICU of the Nijmegen University Hospital (Fig. 2) and data reported in the literature (66, 133,290,299,307,309,333), one-third of the patients with fatal disease die within 6 h after hospital admission and one-third die between 6 and 18 h. Death at a later stage is still determined by the course in the early hours, as shown by the fact that the principal cause of death after 24 h is withdrawal of treatment because of poor neurological prognosis after prolonged cerebral hypoperfusion in the early hours (313).…”

“…Although preterminal cortisol levels do not correlate with mortality (290,548), individual patients may indeed suffer from adrenal insufficiency (43,205,354,522). A Synacthen test performed on day 3 in patients with extensive DIC and shock at the ICU of the Nijmegen University Hospital revealed adrenal insufficiency in 3 of the 23 patients (cortisol increase, Ͻ0.10 mol/liter after 250 g of Synacthen) and an insufficient response in 4 other patients (cortisol increase, Ͻ0.20 mol/liter).…”

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

“…Mortality on our ICU during the study period (n = 118) for group O was 0/9 (0%), for group A 5/45 (11%), for group B 3/22 (14%) and for group C 17/42 (40%). As 60 % of the patients in shock who die, succumb within 16 h after admission (data obtained from the 21 fatalities on our ICU plus 95 reported fatalities) [3,7,13,[28][29][30][31][32], patients at risk should be recognized as early as possible.…”

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

“…Nine other prognostic scoring systems were compared with GMSPS, using the first cohort [4,6,15,17,21,29,34,35,42]. One of the scores [17] was designed for shocked patients and was only evaluated in the subgroup with septic shock.…”