Meningitis: intracranial arterial stenosis increased the risk of dying

Clinical bottom line (level 1b)

  1. Half of patients with bacterial meningitis died or had severe disability.
  2. Patients are more likely to died or had severe disability if they had
    • intracranial arterial stenosis
    • increasing age
Muller et al: Journal of Neurology 1998; 245: 87-92
Expires November 2003

The study

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

Setting: university hospital, Germany

47 patients (aged 18 to 81; mean 53, 70% male) with acute bacterial meningitis (confirmed on blood or CSF culture or serology; pleiocytosis with clinical signs of meningitis)

Factors studied:
  • age, stenosis of intracranial arteries within 8 days, Glasgow coma scale < 13; CSF protein content, focal neurological sign within 8 days
  • age (per advancing year)
  • stenosis of intracranial arteries using transcranial Doppler ultrasound of all major intracranial arteries and submandibular internal carotid artery


    • All patients received penicillin G and/or cefotaxime and gentamicin

    Multivariate regression analysis performed to adjust for confounding factors.

    ?100% followed for ?length of hospital stay
    Outcomes studied:
  • handicapped survival (GOS 2-4) or death (GOS = Glasgow Outcome Scale)

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    handicapped survival (GOS 2-4) or death ?length of hospital stay 26/47 55%
    (41% to 70%)

    prognostic factor for
    handicapped survival (GOS 2-4) or death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    age (per advancing year) ? 26/47
    (55.3%)     		1.05
    (1.01 to 1.11)     		88
    (39 to 410)
    stenosis of intracranial arteries ? 26/47
    (55.3%)     		7.4
    (1.1 to 45.6)     		3
    (2 to 43)

    Comments

    1. This is a study with small sample size; this may account for failure of GCS less than or equal 12, and focal neurological signs in first 8 days to predict for death or handicapped survival.

    Citation

    1. Muller M, Merkelbach S, Hermes M, et al: relationship between short-term outcome and occurrence of cerebral artery stenosis in survivors of bacterial meningitis. Journal of Neurology 1998; 245: 87-92
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Malcolm Daniel

    Clinical Question.
    Patient acute bacterial meningitis
    Intervention or Exposure clinical features, intracranial arterial stenosis
    Outcome death, disability