Prognostic factors in meningococcal disease. Development of a bedside predictive model and scoring system. Barcelona Meningococcal Disease Surveillance Group
N. Barquet, P. Domingo, J. A. Cayla, J. Gonzalez, C. Rodrigo, P. Fernandez-Viladrich, F. A. Moraga-Llop, F. Marco, J. Vazquez, J. A. Saez-Nieto, J. Casal, J. Canela and M. Foz
CAP Gracia, Institut Catala de la Salut, Barcelona, Spain. barquet@tresnet.com
CONTEXT: Meningococcal disease is associated with significant morbidity and
mortality. Development of a prognostic model based on clinical findings may
be useful for identification and management of patients with meningococcal
infection. OBJECTIVES: To construct and validate a bedside model and
scoring system for prognosis in meningococcal disease. DESIGN: Prospective,
population-based study. SETTING: Twenty-four hospitals in the metropolitan
area of Barcelona, Spain. PATIENTS: A total of 907 patients with
microbiologically proven meningococcal disease. Patients diagnosed with
meningococcal disease from 1987 through 1990 were used to develop the
prognostic model, and those diagnosed in 1991 and 1992 were used to
validate it. OUTCOME MEASURES: Clinical independent prognostic factors for
mortality in meningococcal disease. The association between outcome and
independent prognostic factors was determined by logistic regression
analysis. A scoring system was constructed and tested using receiver
operating characteristic curves. RESULTS: Among 624 patients in the
derivation set, 287 (46%) were male, the mean age was 12.4 years, and 34
patients (5.4%) died. Among 283 patients in the validation set, 124 (43.8%)
were male, the mean age was 12.7 years, and 17 patients (6.0%) died. In
multivariate analysis, independent predictors of death were hemorrhagic
diathesis (odds ratio [OR], 101; 95% confidence interval [CI], 30-333),
focal neurologic signs (OR, 25; 95% CI, 7-83), and age 60 years or older
(OR, 10; 95% CI, 3-34), whereas receipt of adequate antibiotic therapy
prior to admission was associated with reduced likelihood of death (OR,
0.09; 95% CI, 0.02-0.4). Hemorrhagic diathesis was scored with 2 points,
presence of focal neurologic signs with 1 point, age of 60 years or older
with 1 point, and preadmission antibiotic therapy was scored as -1. The
clinical scores of -1, 0, 1, 2, and 3 or more points were associated with a
probability of death of 0%, 2.3%, 27.3%, 73.3%, and 100%, respectively.
CONCLUSIONS: Hemorrhagic diathesis, focal neurologic signs, and age of 60
years or older were independent predictors of death in meningococcal
disease, whereas receipt of adequate antibiotic therapy was associated with
a more favorable prognosis. The scoring system presented is simple, is
based on findings readily available at the bedside, and may be useful to
help guide aggressive therapy.
