地塞米松治疗和社区获得性细菌性脑膜炎的预后因素:一项丹麦回顾性人群队列研究

Jacob Bodilsen, Michael Dalager-Pedersen, Henrik Carl Schønheyder, Henrik Nielsen
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引用次数: 27

摘要

社区获得性细菌性脑膜炎(CABM)的发病率和死亡率仍然很高,必须定期评估治疗结果和预后不良的预测因素。我们的目的是描述用地塞米松治疗CABM患者的结果,并评估荷兰脑膜炎风险评分(DMRS)的表现。方法:我们回顾性评估1998-2012年北丹麦地区所有成人CABM患者。结局包括住院死亡率和格拉斯哥结局量表(GOS)评分。GOS得分为5分为有利结果,1-4分为不利结果。我们使用逻辑分析计算相对风险(RRs), 95%置信区间(ci)为年龄、性别和合并症调整后的不利结果。结果:我们共发现了172例CABM。2003年,住院死亡率未受地塞米松实施的影响(19% vs 20%)。地塞米松治疗与脑膜炎的及时诊断和不良结局的风险降低相关(33% vs 53%;调整后RR 0.64, 95% CI 0.41-1.01)和住院死亡率(15% vs 24%;校正RR 0.72, 95% CI 0.35-1.48)。在DMRS中包括的危险因素中,我们发现年龄和心动过速在多变量分析中与不利结果显著相关。结论:使用地塞米松治疗的患者更有可能获得良好的结果,尽管没有达到统计学意义。荷兰风险评分中包含的几个参数在我们的队列中也是负预测因子,尽管由于缺乏数据,整个风险评分无法验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dexamethasone treatment and prognostic factors in community-acquired bacterial meningitis: a Danish retrospective population-based cohort study.

Introduction: The morbidity and mortality in community-acquired bacterial meningitis (CABM) remain substantial and treatment outcomes and predictors of a poor prognosis must be assessed regularly. We aimed to describe the outcome of patients with CABM treated with dexamethasone and to assess the performance of the Dutch Meningitis Risk Score (DMRS).

Methods: We retrospectively evaluated all adults with CABM in North Denmark Region, 1998-2012. Outcomes included in-hospital mortality and Glasgow Outcome Scale (GOS) score. A GOS score of 5 was categorized as a favourable outcome and scores of 1-4 as unfavourable. We used logistic analysis to compute relative risks (RRs) with 95% confidence intervals (CIs) for an unfavourable outcome adjusted for age, sex, and comorbidity.

Results: We identified a total of 172 cases of CABM. In-hospital mortality was unaffected by the implementation of dexamethasone in 2003 (19% vs 20%). Dexamethasone treatment was associated with a prompt diagnosis of meningitis and a statistically insignificant decrease in the risk of an unfavourable outcome (33% vs 53%; adjusted RR 0.64, 95% CI 0.41-1.01) and in-hospital mortality (15% vs 24%; adjusted RR 0.72, 95% CI 0.35-1.48). Of the risk factors included in the DMRS, we found age and tachycardia to be significantly associated with an unfavourable outcome in the multivariate analyses.

Conclusions: Patients treated with dexamethasone were more likely to have a favourable outcome, although statistical significance was not reached. Several parameters included in the Dutch risk score were also negative predictors in our cohort, although the entire risk score could not be validated due to a lack of data.

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