Frontiers in Neurology (Jun 2022)

Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis

  • Johannes Weller,
  • Jonas Simon Enkirch,
  • Felix Lehmann,
  • Alexander Radbruch,
  • Thomas Klockgether,
  • Julian Zimmermann

DOI
https://doi.org/10.3389/fneur.2022.869716
Journal volume & issue
Vol. 13

Abstract

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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.

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