Meningitis With a Negative Cerebrospinal Fluid Gram Stain in Adults: Risk Classification for an Adverse Clinical Outcome

Abstract Objective To derive and validate a risk score for an adverse clinical outcome in adults with meningitis and a negative cerebrospinal fluid (CSF) Gram stain. Patients and Methods We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1...

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Published in:Mayo Clinic proceedings 2012-12, Vol.87 (12), p.1181-1188
Main Authors: Khoury, Nabil T., MD, Hossain, Md Monir, PhD, Wootton, Susan H., MD, Salazar, Lucrecia, MD, Hasbun, Rodrigo, MD, MPH
Format: Article
Language:English
Subjects:
Adolescent
Adult
Adults
Age Factors
Aged
Aged, 80 and over
Biological and medical sciences
Clinical outcomes
Cohort Studies
Female
General aspects
Glucose - cerebrospinal fluid
Humans
Internal Medicine
Logistic Models
Male
Medical sciences
Meningitis
Meningitis - cerebrospinal fluid
Meningitis - complications
Meningitis - etiology
Middle Aged
Neurologic Examination
Original
Outcome Assessment (Health Care)
Patient outcomes
Retrospective Studies
Risk Assessment
Young Adult
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container_issue 12
container_start_page 1181
container_title Mayo Clinic proceedings
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creator Khoury, Nabil T., MD
Hossain, Md Monir, PhD
Wootton, Susan H., MD
Salazar, Lucrecia, MD
Hasbun, Rodrigo, MD, MPH
description Abstract Objective To derive and validate a risk score for an adverse clinical outcome in adults with meningitis and a negative cerebrospinal fluid (CSF) Gram stain. Patients and Methods We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1, 2005, and January 1, 2010. The patients were divided into derivation (N=292) and validation (N=275) cohorts. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model was created using 3 baseline variables that were independently associated with an adverse clinical outcome ( P
doi_str_mv 10.1016/j.mayocp.2012.08.016
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Patients and Methods We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1, 2005, and January 1, 2010. The patients were divided into derivation (N=292) and validation (N=275) cohorts. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model was created using 3 baseline variables that were independently associated with an adverse clinical outcome ( P &lt;.05): age greater than 60 years, abnormal findings on neurologic examination (altered mental status, focal neurologic deficits, or seizures), and CSF glucose level of less than 2.4975 mmol/L (to convert CSF glucose to mmol/L, multiply by 0.05551). The model classified patients into 2 categories of risk for an adverse clinical outcome—derivation sample: low risk, 0.6% and high risk, 32.8%; P &lt;.001; and validation sample: low risk, 0.5% and high risk, 21.1%; P &lt;.001. Conclusion Adults with meningitis and a negative CSF Gram stain can be accurately stratified for the risk of an adverse clinical outcome using clinical variables available at presentation.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.1016/j.mayocp.2012.08.016</identifier><identifier>PMID: 23218086</identifier><identifier>CODEN: MACPAJ</identifier><language>eng</language><publisher>Rochester, MN: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Adults ; Age Factors ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Clinical outcomes ; Cohort Studies ; Female ; General aspects ; Glucose - cerebrospinal fluid ; Humans ; Internal Medicine ; Logistic Models ; Male ; Medical sciences ; Meningitis ; Meningitis - cerebrospinal fluid ; Meningitis - complications ; Meningitis - etiology ; Middle Aged ; Neurologic Examination ; Original ; Outcome Assessment (Health Care) ; Patient outcomes ; Retrospective Studies ; Risk Assessment ; Young Adult</subject><ispartof>Mayo Clinic proceedings, 2012-12, Vol.87 (12), p.1181-1188</ispartof><rights>Mayo Foundation for Medical Education and Research</rights><rights>2012 Mayo Foundation for Medical Education and Research</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.</rights><rights>COPYRIGHT 2012 Elsevier, Inc.</rights><rights>Copyright Mayo Foundation for Medical Education and Research Dec 2012</rights><rights>2012 Published by Elsevier Inc. on behalf of Mayo Foundation for Medical Education and Research. 2012 Mayo Foundation for Medical Education and Research</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c646t-6db45895cf1e2aaebf88c43e641bc4e422ad3e0a43c1c318fef4453220bd0be43</citedby><cites>FETCH-LOGICAL-c646t-6db45895cf1e2aaebf88c43e641bc4e422ad3e0a43c1c318fef4453220bd0be43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547552/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547552/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=26727040$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23218086$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khoury, Nabil T., MD</creatorcontrib><creatorcontrib>Hossain, Md Monir, PhD</creatorcontrib><creatorcontrib>Wootton, Susan H., MD</creatorcontrib><creatorcontrib>Salazar, Lucrecia, MD</creatorcontrib><creatorcontrib>Hasbun, Rodrigo, MD, MPH</creatorcontrib><title>Meningitis With a Negative Cerebrospinal Fluid Gram Stain in Adults: Risk Classification for an Adverse Clinical Outcome</title><title>Mayo Clinic proceedings</title><addtitle>Mayo Clin Proc</addtitle><description>Abstract Objective To derive and validate a risk score for an adverse clinical outcome in adults with meningitis and a negative cerebrospinal fluid (CSF) Gram stain. Patients and Methods We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1, 2005, and January 1, 2010. The patients were divided into derivation (N=292) and validation (N=275) cohorts. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model was created using 3 baseline variables that were independently associated with an adverse clinical outcome ( P &lt;.05): age greater than 60 years, abnormal findings on neurologic examination (altered mental status, focal neurologic deficits, or seizures), and CSF glucose level of less than 2.4975 mmol/L (to convert CSF glucose to mmol/L, multiply by 0.05551). The model classified patients into 2 categories of risk for an adverse clinical outcome—derivation sample: low risk, 0.6% and high risk, 32.8%; P &lt;.001; and validation sample: low risk, 0.5% and high risk, 21.1%; P &lt;.001. 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Patients and Methods We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1, 2005, and January 1, 2010. The patients were divided into derivation (N=292) and validation (N=275) cohorts. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model was created using 3 baseline variables that were independently associated with an adverse clinical outcome ( P &lt;.05): age greater than 60 years, abnormal findings on neurologic examination (altered mental status, focal neurologic deficits, or seizures), and CSF glucose level of less than 2.4975 mmol/L (to convert CSF glucose to mmol/L, multiply by 0.05551). The model classified patients into 2 categories of risk for an adverse clinical outcome—derivation sample: low risk, 0.6% and high risk, 32.8%; P &lt;.001; and validation sample: low risk, 0.5% and high risk, 21.1%; P &lt;.001. Conclusion Adults with meningitis and a negative CSF Gram stain can be accurately stratified for the risk of an adverse clinical outcome using clinical variables available at presentation.</abstract><cop>Rochester, MN</cop><pub>Elsevier Inc</pub><pmid>23218086</pmid><doi>10.1016/j.mayocp.2012.08.016</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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source Open Access: PubMed Central
subjects Adolescent
Adult
Adults
Age Factors
Aged
Aged, 80 and over
Biological and medical sciences
Clinical outcomes
Cohort Studies
Female
General aspects
Glucose - cerebrospinal fluid
Humans
Internal Medicine
Logistic Models
Male
Medical sciences
Meningitis
Meningitis - cerebrospinal fluid
Meningitis - complications
Meningitis - etiology
Middle Aged
Neurologic Examination
Original
Outcome Assessment (Health Care)
Patient outcomes
Retrospective Studies
Risk Assessment
Young Adult
title Meningitis With a Negative Cerebrospinal Fluid Gram Stain in Adults: Risk Classification for an Adverse Clinical Outcome
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