Neuroanesthesia & neurocritical care
Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study
Main finding · Unfavorable outcome (mRS > 2)Result — go to the resultAdjusted odds ratio 2.88 95% CI 1.37–6.21Authors' conclusion
In adults with severe pneumococcal meninigitis, intracranial complications were independently associated with a higher risk of poor functional outcome, in the form of persistent disability or death.
Study context
- Population
- Consecutive adults with pneumococcal meningitis requiring ≥48 h intensive care unit (ICU) stay and undergoing neuroimaging, 2005–2021
- Participants
- 237 adults
- Exposure
- Intracranial complications vs none
- Outcome
- Unfavorable outcome (mRS score > 2)
- Follow-up
- 90 days after ICU admission
Methodological detailsmulticentre
- Multicentre
Main finding
Unfavorable outcome (mRS > 2) · 90 days
Adjusted odds ratio
2.88
95% CI 1.37–6.21
Intracranial complications vs No intracranial complications
aOR 2.88 (95% CI 1.37–6.21)
As reported in the abstract
- Unfavorable outcome, all patients
- 103 patients (44%, 95%CI 37-50)
- Deaths
- 71 (30%)
Observational data: associations, not effects.
Further findings
Intracranial complications on neuroimaging
- At ICU admission
- 68/220 (31%, 95%CI 0.25-0.37)
- During ICU stay
- 75/110 (68%, 95%CI 0.59-0.77)
- Ischemic lesion
- 69/237, 29%
- Diffuse cerebral oedema
- 43/237, 18%
- Ventriculitis
- 36/237, 15%
Other factors associated with unfavorable outcome (multivariable) · 90 days
- Chronic alcohol consumption, aOR
- 3.10 (95% CI 1.27-7.90)
- Chronic vascular disease, aOR
- 4.41 (95% CI 1.58-13.63)
- Focal neurological sign(s), aOR
- 2.38 (95% CI 1.11-5.23)
- CSF leukocyte count < 1000 cell/microL, aOR
- 4.24 (95% CI 2.11-8.83)
Persistent disability (modified Rankin Scale (mRS) 3-5), competing risk ICU-death · 90 days
- Chronic alcohol consumption, cause-specific HR (95% CI 1.83-9.91); sole significant variable
- 4.26
- Remaining variables associated with mortality
- Competing risk analysis
Original publication
Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study. Ann Intensive Care. Published 19 December 2024. doi:10.
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