Early cerebral haemorrhage a potential prognostic marker for community-acquired bacterial meningitis

Community-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. They hypothesized that early intracranial haemorrhage portends a poor prognosis.

Community-acquired bacterial meningitis is an infectious disease with high rates of morbidity and mortality. In clinical practice, prognostication of neurological outcomes in meningitis is difficult. On one hand, patients who are seemingly hopeless may survive and fully recover. On the other hand, deleterious complications such as stroke, brain edema, or hydrocephalus may occur and worsen outcomes. Large prospective studies set out to identify prognostic factors. As expected, advanced age, signs of more severe neurological affection, and systemic inflammation were prognostic for unfavourable outcomes. Other factors remained equivocal, e.g., both absence and presence of otitis were associated with an unfavourable outcome. While some information is available upon diagnosis, other prognostic factors, such as a positive blood culture or the causative pathogen, are available only during the course of the disease

The objective of this study was to evaluate the prognostic impact of early intracranial haemorrhage regardless of size and location on clinical outcome.

Retrospective analysis of patients with community-acquired bacterial meningitis treated at a tertiary academic centre 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.

Results:

A 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 in multivariate analysis, further predictors included ischemic stroke, age, and reduced consciousness

Thus, early cerebral haemorrhage (ECHO) is a potential prognostic marker for clinicians confronted with decision-making in patients who are critically ill with community-acquired bacterial meningitis.

Reference:

Weller Johannes, Enkirch Jonas Simon, Lehmann Felix, Radbruch Alexander, Klockgether Thomas, Zimmermann Julian. Early Intracranial Hemorrhage Predicts Poor Clinical Outcome in Community-Acquired Bacterial Meningitis. Frontiers in Neurology. VOLUME=13.2002. https://www.frontiersin.org/articles/10.3389/fneur.2022.869716. DOI=10.3389/fneur.2022.869716

Keywords:

Early, Intracranial, Hemorrhage, Predicts, Poor, Clinical, Outcome, Community, Acquired, Bacterial, Meningitis, Johannes Weller, Jonas Simon Enkirch, Felix Lehmann, Alexander Radbruch, Thomas Klockgether, Julian Zimmermann, Frontiers in Neurology