Risk factors for intensive care unit admission and mortality among adult meningitis patients
Objectives: To assess the risk factors for intensive care unit admission and inpatient all-cause mortality among adult meningitis patients.
Method: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data between July 2010 and June 2019 of patients of either gender aged 18 years diagnosed with bacterial, viral or tuberculous meningitis. Multivariable logistic regression analyses were used to explore independent predictors of inpatient mortality and intensive care unit admission. Data was analysed using SPSS 24.
Results: Of the 929 patients with suspected meningitis, 506(54.5%) had confirmatory diagnosis. Of them, 303(59.9%) were males. The overall median age of the sample was 47.0 years (interquartile range: 33.0 years). The most common aetiology was bacterial meningitis 324(64%), followed by viral meningitis 141(27.9%). Incidence of inpatient mortality was 53(10.5%), while 75(14.8%) patients required intensive care unit admission. Tuberculous aetiology, intensive care unit admission, concurrent encephalitis, hydrocephalus, inpatient neurosurgery, and longer length of hospital stay were predictors of mortality (p<0.05). Non-indication of blood culture was found to be associated with reduced risk of mortality (p<0.05). For intensive care unit admission, diabetes mellitus, presentation with seizure, imaging suggestive of meningitis, and inpatient neurosurgery were associated with higher risk of admission, while hypertension, presentation with headache, viral aetiology and non-indication of blood culture reduced the risk (p<0.05).
Conclusion: Adult meningitis patients tend to have poor expected outcomes, and their management strategies should be planned accordingly.
Key Words: Meningitis, Mortality, Intensive care units, Critical care, Risk factors.