INDICATORS OF PROGNOSIS IN COMMUNITY-ACQUIRED BACTERIAL MENINGITIS
Bacterial meningitis is a medical, neurological and sometimes neurosurgical emergency, being an important cause of morbidity and mortality worldwide. Aim: Analysis of some epidemiological parameters with possible role in prognosis prediction, and analysis of therapeutic conduct in relation with clinical evolution. Material and methods: Retrospective study of the medical records of 70 patients with a discharge diagnosis of bacterial meningitis. The patients were admitted to the Iasi Infectious Diseases Hospital in 2014 and 2015. Results: A larger number of patients under 50 years of age exhibited the symptomatic associations (fever, headache, stiff neck) compared to those aged over 50 years (p <0.05). Discordance between diagnoses, found in 65.71% of patients correlates with adverse events and death (p = 0.037). A larger proportion of patients on modified therapy (46.67%) died as compared to those in whom treatment was not changed (22.50%) (p = 0.033). We found that a CSF glucose level under 0.4 g/L is more frequently associated with coma (p = 0.002). Statistically significant associations were found between CSF glucose level <0.7 g/L and the following clinical signs and symptoms: fever, headache and neck stiffness (p = 0.043). Patients with pathological changes found at CT examination were more likely to have an unfavorable outcome (p = 0.014). Conclusions: The high rates of comorbidities, the presence of coma and abnormal CT findings on admission, as well as the discordant admission and discharge diagnoses may be considered factors of negative prognosis.
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