Table 2.
Risk factors for death during hospitalization from pneumococcal meningitis in Salvador, Brazil
| Characteristics | No. of cases | No. deaths (%) | Univariate Hazard Ratio (95% CI) | Adjusted Hazard Ratio (95% CI) a |
|---|---|---|---|---|
| Age category | ||||
| <1 years | 189 | 109 (58) | 2.58 (1.90-3.50) | 2.61 (1.54-4.43) |
| 1-4 years | 55 | 27 (49) | 2.20 (1.49-3.24) | 3.14 (1.57-6.29) |
| 5-14 years | 98 | 10 (10) | 0.46 (0.24-0.88) | 0.67 (0.28-1.56) |
| 15-50 years | 170 | 38 (23) | 1.0 | 1.0 |
| >50 years | 33 | 18 (55) | 2.44 (1.61-3.71) | 2.14 (1.11-4.10) |
| Female | 193 | 81 (42) | 1.21 (0.97-1.51) | |
| Underlying conditionb | 141 | 42 (30) | 0.75 (0.57-1.00) | |
| Clinical presentation | ||||
| Seizures prior to hospitalization | 181 | 83 (46) | 1.40 (1.13-1.74) | |
| Coma on admission | 83 | 47 (57) | 1.69 (1.34-2.12) | 2.55 (1.66-3.91) |
| Laboratory values | ||||
| Blood leukocyte count < 15,000 cells/μL | 200 | 89 (44) | 1.36 (1.09-1.69) | 3.53 (2.18-5.71) |
| CSF protein >300 mg/dLc | 308 | 125 (41) | 1.36 (1.07-1.73) | 1.88 (1.12-3.17) |
| Pneumococcal isolate resistant to penicillind | 93 | 45 (48) | 1.39 (1.09-1.78) | 1.62 (1.08-2.43) |
| Serotype 14 | 74 | 36 (49) | 1.38 (1.06-1.80) | 0.52 (0.29-0.91) |
| Treatment | ||||
| Discordant therapy e | 22 | 10 (45) | 1.24 (0.77-1.98) | |
| Systemic corticosteroids f | 412/539 | 159 (39) | 1.25 (0.94-1.68) | |
| ICU admission | 235/548 | 130 (55) | 2.37 (1.88-2.99) |
NOTE: CI, confidence interval; MIC, minimal inhibitory concentration; ICU, intensive care unit.
a Hazard ratios and 95% confidence intervals from multivariable Cox proportional hazards model including age category, presence of coma, CSF protein >300 mg/dL, blood leukocyte count <15,000 cells/μL, penicillin MIC >0.06 μg/ml and serotype 14.
b Includes HIV infection, diabetes mellitus, asplenia, sickle cell disease, congestive heart failure, other disorders associated with immunodepression and recurrent meningitis.
c CSF protein measured at time of admission; data missing for 12 case patients.
d Defined as penicillin MIC >0.06 μg/ml for a pneumococcal isolate from a patient with meningitis.
e Antibiotic therapy was defined as discordant when patients did not receive any antibiotic to which the S. pneumoniae isolate was susceptible during the initial 24 hours of hospitalization.
f Defined as initiation of corticosteroid therapy within 48 hours of admission; information missing for 9 case patients.