Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis
BackgroundCommunity-acquired bacterial meningitis in adults is associated with significant morbidity and mortality; therefore, early prognostication is important to identify severe cases and possibly allocate more intensive treatment. We hypothesized that early intracranial hemorrhage portends a poo...
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| Format: | Article |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.869716/full |
| _version_ | 1811245347733766144 |
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| author | Johannes Weller Jonas Simon Enkirch Felix Lehmann Alexander Radbruch Thomas Klockgether Julian Zimmermann |
| author_facet | Johannes Weller Jonas Simon Enkirch Felix Lehmann Alexander Radbruch Thomas Klockgether Julian Zimmermann |
| author_sort | Johannes Weller |
| collection | DOAJ |
| description | BackgroundCommunity-acquired bacterial meningitis in adults is associated with significant morbidity and mortality; therefore, early prognostication is important to identify severe cases and possibly allocate more intensive treatment. We hypothesized that early intracranial hemorrhage portends a poor prognosis. The objective of this study was to evaluate the prognostic impact of early intracranial hemorrhage regardless of size and location on clinical outcome.MethodsRetrospective analysis of patients with community-acquired bacterial meningitis treated at a tertiary academic center between 2009 and 2019 about patient characteristics, cerebral imaging findings, and clinical outcome. Uni- and multivariable logistic regression analyses were performed to identify independent predictors of poor clinical outcomes defined as a modified Rankin scale score of 5 or 6 upon discharge.ResultsA total of 102 patients were included, of which 22.5% had poor clinical outcomes. Intracranial micro- or macrohemorrhages were present in 7.8% of cases and associated with poor clinical outcomes [odds ratio (OR) 55.75, 95% CI 3.08–1,008.48, p = 0.006] in multivariate analysis, further predictors included ischemic stroke (OR 15.06, 95% CI 1.32–172, p = 0.029), age (OR 2.56, 95% CI 1.4–4.67, p = 0.002), and reduced consciousness (OR 4.21, 95% CI 1.07–16.64, p = 0.04).ConclusionEarly cerebral hemorrhage (ECHO) is a potential prognostic marker for clinicians confronted with decision-making in patients who are critically ill with community-acquired bacterial meningitis. |
| first_indexed | 2024-04-12T14:38:42Z |
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| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T14:38:42Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-3d797fc2e57347f4ac23345c203d21e22022-12-22T03:28:58ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-06-011310.3389/fneur.2022.869716869716Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial MeningitisJohannes Weller0Jonas Simon Enkirch1Felix Lehmann2Alexander Radbruch3Thomas Klockgether4Julian Zimmermann5Department of Neurology, University Hospital Bonn, Bonn, GermanyDepartment of Neuroradiology, University Hospital Bonn, Bonn, GermanyDepartment of Anesthesiology, University Hospital Bonn, Bonn, GermanyDepartment of Neuroradiology, University Hospital Bonn, Bonn, GermanyDepartment of Neurology, University Hospital Bonn, Bonn, GermanyDepartment of Neurology, University Hospital Bonn, Bonn, GermanyBackgroundCommunity-acquired bacterial meningitis in adults is associated with significant morbidity and mortality; therefore, early prognostication is important to identify severe cases and possibly allocate more intensive treatment. We hypothesized that early intracranial hemorrhage portends a poor prognosis. The objective of this study was to evaluate the prognostic impact of early intracranial hemorrhage regardless of size and location on clinical outcome.MethodsRetrospective analysis of patients with community-acquired bacterial meningitis treated at a tertiary academic center between 2009 and 2019 about patient characteristics, cerebral imaging findings, and clinical outcome. Uni- and multivariable logistic regression analyses were performed to identify independent predictors of poor clinical outcomes defined as a modified Rankin scale score of 5 or 6 upon discharge.ResultsA total of 102 patients were included, of which 22.5% had poor clinical outcomes. Intracranial micro- or macrohemorrhages were present in 7.8% of cases and associated with poor clinical outcomes [odds ratio (OR) 55.75, 95% CI 3.08–1,008.48, p = 0.006] in multivariate analysis, further predictors included ischemic stroke (OR 15.06, 95% CI 1.32–172, p = 0.029), age (OR 2.56, 95% CI 1.4–4.67, p = 0.002), and reduced consciousness (OR 4.21, 95% CI 1.07–16.64, p = 0.04).ConclusionEarly cerebral hemorrhage (ECHO) is a potential prognostic marker for clinicians confronted with decision-making in patients who are critically ill with community-acquired bacterial meningitis.https://www.frontiersin.org/articles/10.3389/fneur.2022.869716/fullmeningitiscentral nervous system infectionbacterial meningitiscerebral hemorrhageintracranial hemorrhageclinical outcome |
| spellingShingle | Johannes Weller Jonas Simon Enkirch Felix Lehmann Alexander Radbruch Thomas Klockgether Julian Zimmermann Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis Frontiers in Neurology meningitis central nervous system infection bacterial meningitis cerebral hemorrhage intracranial hemorrhage clinical outcome |
| title | Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis |
| title_full | Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis |
| title_fullStr | Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis |
| title_full_unstemmed | Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis |
| title_short | Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis |
| title_sort | early intracranial hemorrhage predicts poor clinical outcome in community acquired bacterial meningitis |
| topic | meningitis central nervous system infection bacterial meningitis cerebral hemorrhage intracranial hemorrhage clinical outcome |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.869716/full |
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