Meningococcal disease: haemorrhagic diathesis, focal neurologic signs and increasing age increased the risk of death or disability

Clinical bottom line (level 1b)

  1. One in sixteen people with meningococcal disease died within 7 days.
  2. The risk was increased with the following factors
    • bleeding diathesis
    • focal neurologic signs
    • aged 60 or more
    and reduced with pre-admission antibiotics.
  3. One in twenty-seven patients developed permanent or disabling sequelae.
  4. The risk was increased with the following factors
    • haemorrhagic diathesis
    • focal neurologic signs
    • increasing age
    and reduced with pre-admission antibiotics.
Barquet et al: Archives of Internal Medicine 1999; 159 : 2329-2340
Expires October 2004

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 24 acute hospitals, Barcelona, Spain

643 patients (aged 28 days to 89 years mean 14 years: 70% were aged < 15 years, 54% female) with meningococcal disease - confirmed if N. meningitidis isolated from blood culture, CSF or both; or an illness with fever and petechiae diagnosed by a local physician

Factors studied:
  • antibiotics, time to first dose of antibiotics, shock, coma, haemorrhagic diathesis, focal neurologic signs, serological type
  • pre-admission antibiotic
  • aged 60 or more
  • focal neurologic signs
  • haemorrhagic diathesis spontaneous clinically apparent bleeding
  • pre-admission antibiotic
  • aged 15 to 59
  • aged 60 or more
  • focal neurologic signs
  • haemorrhagic diathesis



    Logistic regression was used to adjust for confounding factors.

    followed for discharge from hospital
    Outcomes studied:
  • death
  • permanent or disabling sequelae

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 7 days 41/643 6.4%
    (4.5% to 8.3%)    		 16
    (12 to 22)
    permanent or disabling sequelae - days 24/643 3.7%
    (2.3% to 5.2%)    		 27
    (19 to 44)

    prognostic factor for
    death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    pre-admission antibiotic 7 days 38/361
    (10.5%)     		0.07
    (0.02 to 0.34)     		-10
    (-15 to -10)
    aged 60 or more 7 days 28/595
    (4.7%)     		6.32
    (2.35 to 16.99)     		5
    (2 to 18)
    focal neurologic signs 7 days 31/616
    (5.0%)     		9.86
    (3.26 to 29.83)     		3
    (2 to 10)
    haemorrhagic diathesis 7 days 25/617
    (4.1%)     		63.38
    (20.7 to 194.1)     		1
    (1 to 2)

    prognostic factor for
    permanent or disabling sequelae     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    pre-admission antibiotic - days 21/323
    (6.5%)     		0.16
    (0.04 to 0.58)     		-19
    (-38 to -16)
    aged 15 to 59 - days 7/430
    (1.6%)     		4.79
    (1.65 to 13.89)     		17
    (6 to 97)
    aged 60 or more - days 7/430
    (1.6%)     		6.71
    (1.71 to 26.3)     		12
    (3 to 89)
    focal neurologic signs - days 16/585
    (2.7%)     		15.52
    (4.51 to 53.4)     		4
    (2 to 12)
    haemorrhagic diathesis - days 21/592
    (3.5%)     		20.57
    (3.24 to 130.8)     		3
    (1 to 14)

    Comments

    1. 4.8% of cases were secondary (95% CI: 3.2% to 6.5%)
    2. Serogroup B cases: 56% (95% CI: 52% to 60%). Serogroup C cases: 19% (95% CI: 16% to 22%)
    3. Mortality
      • meningococcaemia: 11.2%
      • meningococcaemia with meningitis: 4.7%
      • meningitis: 4.2%

    Citation

    1. Barquet N, Domingo P, Cayla JA, et al: meningococcal disease in a large urban population (Barcelona, 1987-1992); predictors of dismal prognosis. Archives of Internal Medicine 1999; 159 : 2329-2340
    Search Terms: ?
    Contributor: Chris Ball, October 2001
    Reviewer:

    Clinical Question.
    Patient meningococcal disease
    Intervention or Exposure focal neurology, bleeding, age, pre-admission antibiotic
    Outcome death, disability