Meningitis: anaemia increases the risk of dying

Clinical bottom line (level 2b)

  1. One in thirteen patients with meningococcal meningitis died before discharge.
  2. Patients with anaemia on admission were at increased risk of dying.
Andersen et al: Journal of Infection 1997; 34: 227-235
Expires November 2003

The study

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

Setting: university hospital, Denmark, 1977 to 1990

255 patients (aged 3 months to 84years; median 17, 53% female) with acute meningococcal meningitis(confirmed on culture of CSF or blood)

Excluded if
  • transferred from another hospital after more than 24 hours
  • absence of pleocytosis in CSF
  • clinical or laboratory data unavailable
Factors studied:
  • clinical features (lowered consciousness level, convulsions), blood tests
Multiple logistic regression analysis performed to adjust for confounding factors.

?100% followed for length of hospital stay
Outcomes studied:
  • death

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
death length of hospital stay 19/255 7.5%
(4.2% to 11%)		 13
(9 to 24)

  • A haemoglobin< 110 g/l was independently associated with mortality.

Comments

  1. Pre-admission antibiotic admission reduced the diagnosis of meningococcal meningitis on CSF culture from 72% to 49%, but had no effect on diagnosis by microscopy or blood culture.
  2. Anaemia is an indicator of poor prognosis in many illnesses

Citation

  1. Andersen J, Backer V, Voldsgaard P, et al: acute meningococcal meningitis:analysis of features of the disease according to the age of 255patients. Journal ofInfection 1997; 34: 227-235
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Contributor: Chris Ball and Clare Wotton, November 1999
Reviewer: Luis Ruiz Del Fresno

Clinical Question.
Patient
Intervention or Exposure
Outcome