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The following is a summary of “Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study,” published in the December 2024 issue of Critical Care by Legouy et al. 

Researchers conducted a retrospective study to analyze the association between intracranial complications diagnosed on neuroimaging and neurological outcomes in adults with severe pneumococcal meningitis.  

They evaluated consecutive adults diagnosed with pneumococcal meningitis who required at least 48 hours of intensive care unit (ICU) stay and underwent neuroimaging between 2005 and 2021. The neuroimaging was reanalyzed for intracranial complications, categorized as an ischemic lesion, intracranial hemorrhage, abscess/empyema, ventriculitis, cerebral venous thrombosis, hydrocephalus, and diffuse cerebral edema. The primary outcome was an unfavorable outcome at 90 days after ICU admission, defined by a modified Rankin Scale (mRS) score > 2.  

The results showed that 68/220 (31%, 95% CI 0.25–0.37) of patients with neuroimaging at ICU admission and 75/110 (68%, 95% CI 0.59–0.77) during ICU stay had intracranial complications. At 90 days, 103 patients (44%, 95% CI 37–50) experienced unfavorable outcomes, including 71 deaths (30%). The most common complications were ischemic lesions (69/237, 29%), diffuse cerebral edema (43/237, 18%), and ventriculitis (36/237, 15%). Multivariable analysis revealed that intracranial complications (adjusted odds ratio [aOR] 2.88, 95% CI 1.37–6.21) were linked to unfavorable outcomes, along with chronic alcohol consumption (aOR 3.10, 95% CI 1.27–7.90), chronic vascular disease (aOR 4.41, 95% CI 1.58–13.63), focal neurological signs (aOR 2.38, 95% CI 1.11–5.23), and cerebrospinal fluid leukocyte count <1000 cells/microL (aOR 4.24, 95% CI 2.11–8.83). Competing risk analysis found chronic alcohol consumption (cause-specific hazard ratio 4.26, 95% CI 1.83–9.91) was significantly linked to persistent disability at 90 days, while other factors were associated with mortality.  

Investigators concluded the adults with severe pneumococcal meningitis, intracranial complications were independently associated with a significantly increased risk of poor functional outcome, emphasizing the importance of neuroimaging for both prognostication and patient management. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01405-z