Central Nervous System Infections in the Intensive Care Units and risk factors for mortality; retrospective study

Abstract

Aim: This study was designed to analyze demographic, clinical and laboratory characteristics beside risk factors that affect the mortality rate of patients hospitalized in ICUs with diagnosis of CNS infection. Methods: Patients that have been hospitalized at ICU on pre-CNS infection were retrospectively studied. Beside the clinical laboratory characteristics of the patients, mortality rate and risk factors that affect the mortality were recorded to be analyzed later. Results: Following the evaluation of 118 ICU patients who were suspected to have CNS infection, 62 of them, with full diagnosis of CNS infection, were included in the study. Bacterial meningitis was the diagnosis for 40 (66%) of these patients while 18 of the total (30%) was diagnosed with viral encephalitis and 3 of them (4%) was diagnosed with tuberculous meningitis. When these factors were investigated in a multivariable study, age and time from the onset of symptoms to hospital admission were independent risk factors (CI: 1,098(1,031-1,169), 1,614(1,037-1,278). Conclusion: The mortality rate of the patients that were subjects of the study was 52,5%. Age and time from the onset of symptoms to hospital admission were independent risk factors that affect the mortality.

Keywords

• intensive care
• encephalitis
• menengitis

References

1. 1)Tunkel AR, Van de Beek D, Scheld WM. Acute meningitis. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 7th edn. Philadelphia: Churchill Livingstone-Elsevier; 2010.
2. 2) Solbrig MV, Tyler KL. Infections of the nervous system: viral infections. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, editors. Neurology in Clinical Practice, 5th edn. Philadelphia: Butterworth-Heinemann Elsevier; 2008: pp. 1457–88.
3. 3) Solomon T, Dung NM, Kneen R et al. Japanese encephalitis. J Neurol Neurosurg Psychiatry 2000:68:405–15.
4. 4 )Kalita J, Misra UK, Pandey S et al. A comparison of clinical and radiological findings in adults and children with Japanese encephalitis. Arch Neurol 2003:60:1760–4.
5. 5) Chou CH, Lin GM, Ku CH, Chang FY. Comparison of the APACHE II, GCS and MRC scores in predicting outcomes in patients with tuberculous meningitis. Int J Tuberc Lung Dis. 2010;14(1):86-92.
6. 6) Fernandes D, Gonçalves-Pereira J, Janeiro S, Silvestre J, Bento L, Póvoa P. Acute bacterial meningitis in the intensive care unit and risk factors for adverse clinical outcomes: retrospective study. J Crit Care. 2014;29(3):347-350. doi:10.1016/j.jcrc.2013.12.001
7. 7) Edberg M, Furebring M, Sjölin J, Enblad P. Neurointensive care of patients with severe community-acquired meningitis. Acta Anaesthesiol Scand. 2011;55(6):732-739. doi:10.1111/j.1399-6576.2011.02460.x
8. 8) Trachtenberg JD, Kambugu AD, McKellar M et al. The medical management of central nervous system infections in Uganda and the potential impact of an algorithm-based approach to improve outcomes. Int J Infect Dis 2007:11:524–30.

9. 9) Thakur KT, Motta M, Asemota AO et al. Predictors of outcome in acute encephalitis. Neurology 2013;81:793–800.
10. 10)Proulx N, Fréchette D, Toye B, Chan J, Kravcik S. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM. 2005;98(4):291-298. doi:10.1093/qjmed/hci047
11. 11)McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry. 1997;63(3):321-326.
12. 12)Raschilas F, Wolff M, Delatour F, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis. 2002;35(3):254-260. doi:10.1086/341405 doi:10.1136/jnnp.63.3.
13. 13) Ziai WC, Lewin JJ 3rd. Update in the diagnosis and management of central nervous system infections. Neurol Clin. 2008;26(2):427-viii. doi:10.1016/j.ncl.2008.03.013)
14. 14)Ziai WC, Lewin JJ 3rd. Update in the diagnosis and management of central nervous system infections. Neurol Clin. 2008;26(2):427-viii. doi:10.1016/j.ncl.2008.03.013)
15. 15)Sanaei Dashti A, Alizadeh S, Karimi A, Khalifeh M, Shoja SA. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis: A cross-sectional study. Medicine (Baltimore). 2017;96(35):e7637. doi:10.1097/MD.0000000000007637.
16. 16)Misra UK, Kalita J, Bhoi SK. Spectrum and outcome predictors of central nervous system infections in a neurological critical care unit in India: a retrospective review. Trans R Soc Trop Med Hyg. 2014;108(3):141-146. doi:10.1093/trstmh/tru008,
17. 17)Flores-Cordero JM, Amaya-Villar R, Rincón-Ferrari MD, et al. Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors. Intensive Care Med. 2003;29(11):1967-1973. doi:10.1007/s00134-003-1935-4
18. 18) Chou CH, Lin GM, Ku CH, Chang FY. Comparison of the APACHE II, GCS and MRC scores in predicting outcomes in patients with tuberculous meningitis. Int J Tuberc Lung Dis. 2010;14(1):86-92.
19. 19) Pietraszek-Grzywaczewska I, Bernas S, Łojko P, Piechota A, Piechota M. Predictive value of the APACHE II, SAPS II, SOFA and GCS scoring systems in patients with severe purulent bacterial meningitis. kk. 2016;48(3):175-179. doi:10.5603/AIT.a2016.0030
20. 20) Lai WA, Chen SF, Tsai NW, et al. Clinical characteristics and prognosis of acute bacterial meningitis in elderly patients over 65: a hospital-based study. BMC Geriatr. 2011;11:91. Published 2011 Dec 28. doi:10.1186/1471-2318-11-91
21. 21) Edberg M, Furebring M, Sjölin J, Enblad P. Neurointensive care of patients with severe community-acquired meningitis. Acta Anaesthesiol Scand. 2011;55(6):732-739. doi:10.1111/j.1399-6576.2011.02460.x