Factors Associated with In-Hospital Mortality in Adult Patients with Bacterial Meningitis

Background/Objectives: The aim of this study was to evaluate the association between various clinical and laboratory findings and in-hospital mortality in community-acquired bacterial meningitis (BM). Methods: We retrospectively analyzed 339 adult (>= 18 years old) patients with bacterial meningitis who were admitted to the Hospital for Infectious Diseases in Warsaw between January 2010 and December 2017. Results: Altogether, 56 patients (16.5%) died during hospitalization. On admission, the non-survivors scored lower on the Glasgow Coma Scale (GCS) (median 7 vs. 13, p < 0.001) and higher on the Sequential Organ Failure Assessment (SOFA) score (median 6 vs. 2, p < 0.001) and were less likely to complain about headaches (18.75% vs. 54.21%, p < 0.001) and nausea and/or vomiting (1.89% vs. 36.2%, p < 0.001), but were more likely to manifest peripheral nerve palsies (21.43% vs. 9.61%, p = 0.02). The patients who died were also more likely to be immunocompromised (53.57% vs. 34.28%, p = 0.01), have Streptococcus pneumoniae etiology (35.71% vs. 16.25%, p = 0.001), higher concentrations of procalcitonin (median 5.035 ng/mL vs. 2.245 ng/mL, p = 0.003) and urea (median 10.7 mmol/L vs. 5.865 mmol/L, p < 0.001) in the blood and higher protein (median 4.57 g/L vs. 2.605 g/L, p = 0.014) and lower glucose levels (median 0.765 mmol/L vs. 1.89 mmol/L, p = 0.006) in the cerebrospinal fluid (CSF). In a multiple logistic regression analysis, which was conducted separately for the GCS and SOFA, both scoring systems (OR = 0.67, OR 95% CI 0.59-0.75, p < 0.001 for GCS and OR = 1.42, OR 95% CI 1.29-1.60, p < 0.001 for SOFA) as well as an age over 70 years (OR = 3.99, OR 95% CI 1.39-12.93, p = 0.014) and Streptococcus pneumoniae etiology (OR = 2.38, OR 95% CI 1.12-4.99, p = 0.022) were associated with in-hospital deaths. Conclusions: The survivors and non-survivors with BM differed with respect to a number of signs and symptoms, etiology, the results of blood and CSF laboratory tests, and the immune deficiency status, as well as the GCS and SOFA scores. In the multiple logistic regression analysis, both of the GCS and SOFA scoring systems, age and Streptococcus pneumoniae etiology showed high associations with the in-hospital deaths.