Clinical Characteristics And Risk Factors For Short-term Adverse Prognosis Of Childhood Purulent Meningitis

【Objective】To investigate the risk factors for short-term adverse prognosis of childhoodpurulent meningitis, early identificate the patients at risk and provide theoretical basis forguiding clinical treatment.【Methods】Atotal of89purulent meningitis patients admitted to The FirstAffiliatedHospital of Fujian Medical University pediatric wards,from January1,2005to December31,2013,were analyzed retrospectively. According to Glasgow Outcome Score, all cases weredivided into two groups,favorable and adverse outcome groups. We compared differencesbetween the two groups in basic characteristics,clinical manifestations, complications,laboratory examinations,treatment,etc.Univariate and multivariate logistic regression modelswere used to determine the risk factors for short-term adverse prognosis of childhood purulentmeningitis.All datas were analyzed by statistical software SPSS19.0, taking α=0.05as thesignificant test standard.【Results】89cases of childhood purulent meningitis were included in this study. Glasgowoutcome scores showed that:58(65.17%) cases were cured,17(19.10%) clinical improved,10(11.24%) with neurological sequelae,and4cases died during hospitalization;and the casefatality rate was4.49%.Finally,14(15.73%) cases presented adverse outcome and75(84.27%)were favorable.Univariate analysis showed that age of onset,vomiting,disturbance ofconsciousness/coma,convulsions,pupillary light reflex slowness,dystonia,complications,brainCT/MRI abnormalities,CRP,CSF glucose,CSF protein,CSF lactic acid,CSF/blood glucoseratio,hypocalcemia,using gamma globulin, overall15indicators,were associated with poorprognosis of children with purulent meningitis;Logistic regression analysis showed thatage(OR=0.501,95%CI:0.297～0.845;P=0.01),CSF/blood glucose ratio (OR=0.001,95%CI:0～0.364;P=0.021) were protective factors for adverse outcome and disturbance ofconsciousness/coma(OR=16.516,95%CI:1.287～211.923;P=0.031),convulsions (OR=7.735,95%CI:1.159～51.605;P=0.035),CSF lactic acid(OR=1.725,95%CI:1.05～2.835;P=0.032)were independent risk factors.【Conclusions】The risk factors for an adverse outcome of childhood purulent meningitis were young age,disturbance of consciousness/coma,convulsions,decreased CSF/blood glucoseratio,increased CSF lactic acid.Early identification of patients with the risk factors of poorprognosis is important.Then we could take adequate,effective measures and more aggressivetreatment as soon as possible for the patients at risk to improve the prognosis.