Meningococcal disease: a clinical prediction rule based on 4 factors helped rank the risk of dying at 7 days

Clinical bottom line (level 1b)

  1. One in seventeen patients with meningococcal disease died within 7 days.
  2. The risk of dying was increased with
    • haemorrhagic diathesis
    • focal neurologic signs
    • aged 60 or more
    and was reduced with preadmission antibiotics.
  3. A clinical prediction rule helped rank patients for risk of dying at 7 days.
Barquet et al: Journal of the American Medical Association 1997; 278 : 491-496
Expires February 2004

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: 24 acute hospitals, Barcelona, Spain

283 patients (aged mean 12, 56% female) (validation set) with microbiologically proven meningococcal disease (isolated from blood, CSF or both)

Factors studied:
  • age, sex, comorbid conditions, upper respiratory tract infection in previous 5 days, preadmission antibiotic therapy, clinical form of meningococcal disease, meningeal signs, haemorrhagic diathesis (spontaneous clinical bleeding), coma, focal neurologic signs
  • preadmission antibiotic
  • aged 60 or more
  • focal neurologic signs
  • haemorrhagic diathesis



    Logisitic regression analysis was used to adjust for confounding factors.

    100% followed for 7 days
    Outcomes studied:
  • death
  • death with score 2 or more
  • death with score: 1
  • death with score: 0
  • death with score: -1
    • The derivation set consisted of 624 patients (mean age 12.4; 54% male).
    • Clinical prediction guide: summed score
      • haemorrhagic diathesis: 2
      • focal neurologic signs: 1
      • aged 60 or more: 1
      • preadmission antibiotic: -1

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NF
    (95% CI)
    death 7 days 17/283 6.0%
    (3.2% to 8.8%)    		 17
    (11 to 31)
    death with score 2 or more 7 days 8/10 80%
    (55% to 100%)    		 1
    (1 to 2)
    death with score: 1 7 days 6/20 30.0%
    (9.9% to 50%)    		 3
    (2 to 10)
    death with score: 0 7 days 3/158 1.9%
    (0.0% to 4.0%)    		 53
    (25 to infinity)
    death with score: -1 7 days 0/92 0.0%
    (0.0% to 1.1%)    		 -
    (91 to infinity)

    prognostic factor for
    death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    preadmission antibiotic 7 days 2/223
    (0.90%)     		0.09
    (0.02 to 0.43)     		-120
    (-200 to -110)
    aged 60 or more 7 days 26/563
    (4.6%)     		10.08
    (2.95 to 34.48)     		4
    (2 to 13)
    focal neurologic signs 7 days 26/575
    (4.5%)     		24.60
    (7.25 to 83.49)     		2
    (1 to 5)
    haemorrhagic diathesis 7 days 20/582
    (3.4%)     		100.7
    (30.44 to 332.8)     		1
    (1 to 2)

    Citation

    1. Barquet N, Domingo P, Cayla JA, et al: prognostic factors in meningococcal disease: development of a bedside predictive model and scoring system. Journal of the American Medical Association 1997; 278 : 491-496
    Search Terms: Citation in 'Evidence-based Diagnosis'; Ebell M, 2001
    Contributor: Chris Ball, October 2001
    Reviewer:

    Clinical Question.
    Patient meningococcal disease
    Intervention or Exposure haemorrhagic diathesis, age, focal neurologic signs, preadmission antibiotic
    Outcome death