Clinical and laboratory findings as prognostic factors of meningococcemia (2006-2010)

Abstract

Objective - Through our study we sought to evaluate clinical and laboratory findings as prognostic factors for meningococcemia in our country, and the predictive value of the Stiehm and Damrosch criteria and the Glasgow Meningococcal Septicemia Prognostic score (GMSPS).

Material and methods - This is a retrospective study. We evaluated the clinical and laboratory findings for all patients: age, presence of meningitis, presence of shock, time of petechial presentation, white blood cell count, platelet count, erythrocyte sedimentation rate (ESR), base deficit, and their relation to the mortality of these patients. To assess the severity of meningococcal septicemia we used two scores: the Stiehm and Damrosch criteria and GMSPS.

Results - Twenty-five patients were admitted to the Pediatric Intensive Care Unit (PICU) with meningococcemia during the study period. Ten deaths were recorded, representing an overall mortality rate of 40%. Sixteen cases (64%) were associated with meningitis. All patients with thrombocytopenia <40000/mm3 died within 24 hours. Leucopenia was found in 64% of patients, 63% of them with fatal outcome. All deceased patients had a base deficit >8mEq/l. The sensitivity was 100%, specificity was 100%, positive predictive value was 100% and negative predictive value was 100% for a score >5 of GMSPS. For Stiehm and Damrosch (>2 criteria) the sensitivity was 90%, specificity was 80%, positive predictive value was 75% and negative predictive value was 92.3%.

Conclusion - Leucopenia, thrombocytopenia, severe basis deficit, low ESR rate, absence of meningitis and shock were significant findings, predicting mortality in these patients. Both prognostic scores, Stiehm and Damrosch and GMSPS, were accurate in identifying patients with good outcome and predicting poor outcome, without statistical significance between them.