The Analyses Of Predictive Factors For Adverse Prognosis In Children With Streptococcus Pneumoniae Meningitis

Backgrounds and objectives:Streptococcus pneumoniae meningitis(SPM)is a serious infectious disease of the central nervous system.Although treatment regimens for SPM(e.g.,antibiotics,adjunct therapy with corticosteroids and human immunoglobulin)are still improving,the mortality rate and sequelae rate of nervous system of the survivors remain high.So we should delve into the possible risk factors that may lead to a poor prognosis for children with SPM.It has important clinical implications for reducing mortality and improving the quality of life in children with SPM.The aims of this study are to explore the potential predisposing causes of children with SPM and predicitive factors for childhood death from SPM in order to guide the first-line clinicians to evaluate the prognosis of the patients in the early stages and give more aggressive and targeted treatment for children with poor prognosis,with the goal of better managing patients and improving the quality of life for children with SPM.Methods:A tatal of 32 pneumococcal meningitis patients enrolled in the Affiliated Children’s Hospital of Soochow University,from November 2010 to December 2015,were analyzed retrospectively.According to their prognosis during hospitalization,the subjects were divided into the death group and survival group.We compared differences between the two groups in basic characteristics,clinical symptoms and signs,laboratory examinations,treatment and complications by using t test,Fisher’s exact probability test and rank sum test and selected the correlation factors of statistical significance.Univariate and multivariate logistic regression models were used to explore the potential causes and the predictive factors of children with Streptococcus pneumococcal meningitis.Data were entered and cleaned by using Microsoft Excel.The SPSS 21 statistical software was used to analyze the data.A two-sided P value<0.05 indicated statistical significance.Results:1、Among the 32 children diagnosed with pneumococcal meningitis,11 cases died and the incidence was 34.4%.2、Twenty episodes occurred in male patients.Twelve episodes occurred in female patients.The ratio of male and female was 1.67:1.The ages of the patients ranged from 2.6months to 108 months.Twenty-one episodes(65.6%)occurred in patients below the age of2 years.Specific predisposing factors such as ear abnormalities were found in 7patients.Among them,3 cases had histories of electronic cochlear implants.One each of the remaining 4 patients had congenital deafness,congenital deafness with cerebrospinal rhinorrhoea,otomastoiditis,and a history of resection surgery for an ear neoplasm.3、There were significant statistically differences in endotracheal tube intubation,shock within 24 hours after admission,cultures of blood and CSF double positive,the levels of cerebrospinal fluid(CSF)IgM,CSF IgG,CSF IgA,CSF leukocyte,CSF protein,CSFadenosinedeaminase(ADA),serumsodium(Na~+),serumlactic acid(LA),serumlactatedehydrogenase(LDH),serumC-reactive protein(CRP)and platelet(PLT)between the death group and survival group.4、Univariate analysis showed that overall 10 indicators of shock within 24 hours after admission,cultures of blood and CSF double positive,the levels of CSF IgM,CSF IgG,CSF protein,CSF ADA,serum LA,serum LDH,serum CRP and PLT were associated with death of children with pneumococcal meningitis.5、Using the indexs of cultures of blood and CSF double positive and the levels of serum LA,serum CRP and PLT as independent variables,the death during hospitalization as the dependent variable,logistic regression analysis showed that the level of serum CRP,cultures of blood and CSF double positive were independent risk factors.Conclusions:1、The children of Streptococcus pneumoniae meningitis had a poor prognosis and high mortality.2、The incidence of Streptococcus pneumoniae meningitis was higher in children younger than 2 years old,male,otitis media and cochlear implantation.3、The predicitive factors associated with mortality in pediatric SPM included shock within 24 hours after admission,thrombocytopenia,as well as high serum LA level,high serum LDH level,high CSF-ADA level,high CSF protein level,high CSF-IgG level,high CSF-IgM level,relatively high serum CRP level or cultures of blood and CSF double positive.Low serum CRP level and cultures of blood and CSF double positive were independent risk factors.4、The inclusion of pneumococcal vaccines in our country’s planned vaccination is worth advocating.Timely immunization should be carried out to the high-risk population of Streptococcus pneumoniae infection.