Meningitis Research Today is a free monthly online journal that collates and summarizes the latest research about Meningitis, including details on viral, bacterial, spinal, symptoms, treatment.

Coagulation, coma, and outcome in bacterial meningitis--an observational study of 38 adult cases.

Kowalik MM, Smiatacz T, Hlebowicz M, Pajuro R, Trocha H

Department of Anaesthesiology and Intensive Therapy, Medical University of Gdańsk, ul. Debinki 7, 80-211 Gdańsk, Poland. mkowalik@amg.gda.pl

OBJECTIVES: The purpose of this study was to evaluate the epidemiology of intravascular coagulation in bacterial meningitis and to recognise the associations with disease severity and outcome. METHODS: Thirty-eight consecutively admitted adult patients with microbiologically proven bacterial meningitis were observed prospectively for platelets count (PLT), platelets-decline (dPLT), prothrombin ratio (PTr), INR, and D-dimer levels during the first three days in relation to disease severity (Glasgow Coma Scale--GCS, APACHE-III) and outcome (Glasgow Outcome Scale--GOS). RESULTS: The prevalence of activated coagulation measured by abnormal laboratory results varied respectively: PTr--30%, INR--36%, PLT--38%, dPLT--50%, and D-dimer--88%. Patients with GCS <9 at admission presented with laboratory results suggesting triggered coagulation: dPLT 48 vs. 15%/day (p=0.0246), INR 1.6 vs. 1.12 (p=0.0014), PTr 76 vs. 93% (p=0.0020). An unfavourable outcome (GOS 1-4) was observed in 42% of patients and was associated with: PLT <170 or >265 G/L (OR--24.4; p=0.0006), PTr <82% (OR--5.00; p=0.0388), INR >1.1 (OR--5.04; 0.0336), and D-dimer >850 ng/ml (OR--24.0; p=0.0033). CONCLUSIONS: Coagulation was activated in a majority of patients with bacterial meningitis and related to coma and unfavourable outcome.

Published 13 July 2007 in J Infect, 55(2): 141-8.
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