Introduction
Materials and methods
Subjects
Diagnostic methods
Statistical analysis
Results
Demographic data and clinical comparisons
Characteristic | With fulminant course N = 69 (%) | With non-fulminant course N = 58 (%) | ORa | 95% CIa | p-value | ORb | 95% CIb | Adjusted p-value |
---|---|---|---|---|---|---|---|---|
Age | 58.36 ± 15.36 | 56.47 ± 15.03 | 0.485 | |||||
Gender | ||||||||
Male | 47 (68.1) | 41 (70.7) | 1.129 | 0.529–2.411 | 0.754 | |||
Female | 22 (31.9) | 17 (29.3) | ||||||
Outcome | ||||||||
In-hospital mortality | ||||||||
<72 h | 8 (21.6) | 0 (0.0) | 1.276 | 1.078–1.511 | 0.038* | - | - | 0.999 |
>72 h | 13 (35.1) | 0 (0.0) | 1.541 | 1.217–1.953 | 0.005* | - | - | 0.999 |
Discharge mRS | ||||||||
At discharge | 4.57 ± 1.90 | 2.97 ± 2.39 | < 0.001* | - | - | 0.999 | ||
Three months later | 4.30 ± 2.24 | 2.74 ± 2.57 | < 0.001* | - | - | 0.999 | ||
Mortality | 35 (50.7) | 16 (27.6) | 1.839 | 1.141–2.964 | 0.008* | - | - | 0.583 |
Underlying condition | ||||||||
Diabetes mellitus | 34 (49.3) | 22 (37.9) | 1.299 | 0.865–1.952 | 0.200 | |||
Liver cirrhosis | 16 (23.2) | 7 (12.1) | 1.921 | 0.849–4.348 | 0.105 | |||
Alcoholism | 15 (21.7) | 6 (10.3) | 2.101 | 0.872–5.066 | 0.085 | |||
Systemic malignancy | 9 (13.0) | 13 (22.4) | 0.582 | 0.268–1.263 | 0.165 | |||
Intracranial hemorrhage | 7 (10.1) | 11 (19.0) | 0.535 | 0.222–1.291 | 0.156 | |||
End-stage renal disease | 10 (14.5) | 1 (1.7) | 8.406 | 1.109–63.732 | 0.011* | 12.474 | 0.740–210.300 | 0.080 |
Substance abuser | 3 (4.3) | 2 (3.4) | 1.261 | 0.218–7.291 | 0.795 | |||
Brain tumor | 1 (1.4) | 3 (5.2) | 0.280 | 0.030–2.622 | 0.231 | |||
Immunocompromised state | 41 (59.4) | 26 (44.8) | 1.326 | 0.938–1.873 | 0.101 | |||
Clinical manifestations | ||||||||
Fever | 59 (85.5) | 51 (87.9) | 0.972 | 0.849–1.114 | 0.689 | |||
Initial altered consciousness | 63 (91.3) | 37 (63.8) | 1.431 | 1.164–1.761 | < 0.001* | 8.068 | 0.392-166.198 | 0.176 |
Seizure | 32 (46.4) | 9 (15.5) | 2.989 | 1.557–5.736 | < 0.001* | 2.879 | 0.294–28.165 | 0.363 |
Septic shock | 28 (40.6) | 3 (5.2) | 7.845 | 2.513–24.490 | < 0.001* | 10.337 | 1.020-104.759 | 0.048* |
Hydrocephalus | 15 (21.7) | 16 (27.6) | 0.788 | 0.427–1.453 | 0.445 | |||
Hyponatremia | 16 (23.2) | 5 (8.6) | 2.690 | 1.049–6.897 | 0.028* | 0.823 | 0.077–8.824 | 0.872 |
DKA/HHS | 14 (20.3) | 5 (8.6) | 2.354 | 0.902–1.006 | 0.066 | |||
Brain abscess | 11 (15.9) | 6 (10.3) | 1.541 | 0.607–3.911 | 0.356 | |||
Ischemic infarct | 11 (15.9) | 4 (6.9) | 2.312 | 0.777–6.874 | 0.116 | |||
Liver abscess | 6 (8.7) | 5 (8.6) | 1.009 | 0.324–3.136 | 0.988 | |||
Vasculitis | 7 (10.1) | 3 (5.2) | 1.961 | 0.531–7.245 | 0.300 | |||
Subdural empyema | 3 (4.3) | 1 (1.7) | 2.522 | 0.270-23.595 | 0.399 | |||
Spinal abscess | 1 (1.4) | 3 (5.2) | 0.280 | 0.030–2.622 | 0.231 | |||
Infective endocarditis | 2 (2.9) | 2 (3.4) | 0.841 | 0.122–5.783 | 0.860 | |||
Bacteremia | 37 (53.6) | 20 (34.5) | 1.555 | 1.025–2.360 | 0.031* | 0.373 | 0.051–2.716 | 0.330 |
Cerebrospinal fluid | ||||||||
Median (IQR) Glucose level (mmol/L) | 1.67 (0.28, 4.58) | 1.39 (0.28, 3.69) | 0.181 | |||||
Median (IQR) Total protein level (g/L) | 5.07 (2.36, 7.85) | 2.71 (1.44, 4.23) | < 0.001* | 0.994–1.001 | 0.110 | |||
Median (IQR) Lactate level (mmol/L) | 13.97 (8.55, 18.43) | 11.54 (6.72, 19.09) | 0.890 | |||||
Median (IQR) WBC counts (109/L) | 1.07 (0.25, 5.38) | 0.72 (0.09, 1.96) | 0.827 |
Implicated pathogens
Pathogen | With fulminant course (N = 69) | With non-fulminant course (N = 58) | p value |
---|---|---|---|
Gram-negative | |||
Klebsiella pneumoniae | 33 | 17 | 0.040* |
Pseudomonas aeruginosa | 1 | 2 | 0.492 |
Other Pseudomonas species | 2 | 2 | 0.906 |
Escherichia coli | 3 | 4 | 0.325 |
Neisseria meningitidis | 1 | 1 | 0.934 |
Proteus mirabilis | 0 | 1 | 0.287 |
Salmonella enterica serogroup B | 0 | 1 | 0.287 |
Salmonella enterica serogroup D | 0 | 1 | 0.287 |
Chryseobacterium meningosepticum | 1 | 0 | 0.343 |
Sphingomonas paucimobilis | 1 | 0 | 0.343 |
Roseomonas mucosa | 1 | 0 | 0.343 |
Fusobacterium nucleatum | 0 | 1 | 0.287 |
Gram-positive | |||
Staphylococcus aureus | 6 | 5 | 0.638 |
Coagulase-negative staphylococci | 1 | 2 | 0.492 |
Streptococcus pneumoniae | 6 | 5 | 0.908 |
Viridans streptococci | 5 | 8 | 0.153 |
β-streptococcus group B | 1 | 1 | 0.934 |
Listeria monocytogenes | 4 | 4 | 0.865 |
Enterococcus faecalis | 3 | 0 | 0.343 |
Mixed infection | 0 | 3 | 0.063 |
Analysis of prognostic factors
Characteristic | With fulminant course N = 34 (%) | With non-fulminant course N = 42 (%) | ORa | 95% CIa | p-value | ORb | 95% CIb | Adjusted p-value |
---|---|---|---|---|---|---|---|---|
Age | 56.32 ± 16.95 | 55.29 ± 15.73 | 0.783 | |||||
Gender | ||||||||
Male | 24 (70.6) | 30 (71.4) | 1.042 | 0.385–2.821 | 0.936 | |||
Female | 10 (29.4) | 12 (28.6) | ||||||
Initial consciousness level (Glasgow coma scale) | 6.21 ± 1.43 | 13.07 ± 2.51 | < 0.001* | - | - | 0.984 | ||
Outcome (mRS) | ||||||||
At discharge | 3.09 ± 1.73 | 1.81 ± 1.73 | 0.002* | - | - | 0.991 | ||
Three months later | 2.56 ± 2.03 | 1.50 ± 1.85 | 0.020* | - | - | 0.988 | ||
Underlying condition | ||||||||
Diabetes mellitus | 20 (58.8) | 17 (40.5) | 1.453 | 0.915–2.307 | 0.112 | |||
Systemic malignancy | 5 (14.7) | 7 (16.7) | 0.882 | 0.307–2.534 | 0.816 | |||
Liver cirrhosis | 7 (20.6) | 3 (7.1) | 2.882 | 0.806–10.312 | 0.085 | |||
Intracranial hemorrhage | 3 (8.8) | 10 (23.8) | 0.371 | 0.111–1.241 | 0.085 | |||
Alcoholism | 5 (14.7) | 4 (9.5) | 1.544 | 0.449–5.307 | 0.487 | |||
End-stage renal disease | 4 (11.8) | 0 (0.0) | 1.134 | 1.002–1.282 | 0.022* | - | - | 0.998 |
Substance abuser | 1 (2.9) | 2 (4.8) | 0.618 | 0.058–6.525 | 0.685 | |||
Brain tumor | 1 (2.9) | 1 (2.4) | 1.235 | 0.080-19.029 | 0.879 | |||
Immunocompromised state | 18 (52.9) | 12 (28.6) | 1.853 | 1.044–3.289 | 0.031* | - | - | 0.999 |
Clinical manifestations | ||||||||
Fever | 30 (88.2) | 37 (88.1) | 1.002 | 0.849–1.182 | 0.985 | |||
Seizure | 17 (50.0) | 5 (11.9) | 4.200 | 1.727–10.214 | < 0.001* | - | - | 1.000 |
Hydrocephalus | 7 (20.6) | 10 (23.8) | 0.865 | 0.368–2.030 | 0.738 | |||
DKA/HHS | 9 (26.5) | 4 (9.5) | 2.779 | 0.937–8.246 | 0.051 | |||
Hyponatremia | 10 (29.4) | 1 (2.4) | 12.353 | 1.663–91.760 | 0.001* | - | - | 0.999 |
Brain abscess | 7 (20.6) | 4 (9.5) | 2.162 | 0.690–6.774 | 0.173 | |||
Septic shock | 10 (29.4) | 0 (0.0) | 1.416 | 1.140–1.761 | < 0.001* | - | - | 1.000 |
Ischemic infarct | 7 (20.6) | 3 (7.1) | 2.882 | 0.802–10.312 | 0.085 | |||
Liver abscess | 3 (8.8) | 3 (7.1) | 1.235 | 0.266–5.7341 | 0.787 | |||
Vasculitis | 4 (11.8) | 3 (7.1) | 1.647 | 0.395–6.862 | 0.488 | |||
Subdural empyema | 3 (8.8) | 1 (2.4) | 3.706 | 0.403–34.038 | 0.211 | |||
Spinal abscess | 0 (0.0) | 2 (4.8) | 0.952 | 0.890–1.019 | 0.197 | |||
Infective endocarditis | 1 (2.9) | 1 (2.4) | 1.235 | 0.080-19.029 | 0.879 | |||
Bacteremia | 17 (50.0) | 12 (28.6) | 1.750 | 0.975–3.140 | 0.056 | |||
Cerebrospinal fluid | ||||||||
Median (IQR) Glucose level (mmol/L) | 1.67 (0.28, 6.60) | 1.94 (0.28, 3.97) | 0.180 | |||||
Median (IQR) Total protein level (g/L) | 6.15 (2.01, 7.69) | 2.66 (1.36, 4.65) | 0.012* | - | - | 0.992 | ||
Median (IQR) Lactate level (mmol/L) | 13.54 (8.66, 17.76) | 10.55 (6.74, 21.84) | 0.796 | |||||
Median (IQR) WBC counts (109/L) | 1.25 (0.20, 6.67) | 0.73 (0.08, 1.84) | 0.911 |
Characteristic | Mortality N = 35 (%) | Survival N = 34 (%) | ORa | 95% CIa | p-value |
---|---|---|---|---|---|
Age | 60.34 ± 13.58 | 56.32 ± 16.95 | 0.280 | ||
Gender | |||||
Male | 23 (65.7) | 24 (70.6) | 1.252 | 0.454–3.457 | 0.664 |
Female | 12 (34.3) | 10 (29.4) | |||
Initial consciousness level (Glasgow coma scale) | 5.71 ± 1.93 | 6.21 ± 1.43 | 0.234 | ||
Inappropriate antibiotics use | 12 (34.3) | 12 (35.3) | 1.045 | 0.388–2.816 | 0.930 |
Underlying condition | |||||
Diabetes mellitus | 14 (40.0) | 20 (58.8) | 0.680 | 0.415–1.114 | 0.118 |
Liver cirrhosis | 9 (25.7) | 7 (20.6) | 1.249 | 0.524–2.974 | 0.614 |
Alcoholism | 10 (28.6) | 5 (14.7) | 1.943 | 0.741–5.096 | 0.163 |
End-stage renal disease | 6 (17.1) | 4 (11.8) | 1.457 | 0.451–4.713 | 0.526 |
Systemic malignancy | 4 (11.4) | 5 (14.7) | 0.777 | 0.228–2.651 | 0.686 |
Intracranial hemorrhage | 4 (11.4) | 3 (8.8) | 1.295 | 0.313–5.362 | 0.720 |
Substance abuser | 2 (5.7) | 1 (2.9) | 1.943 | 0.185–20.446 | 0.572 |
Brain tumor | 0 (0.0) | 1 (2.9) | 0.971 | 0.916–1.029 | 0.307 |
Immunocompromised state | 23 (65.7) | 18 (52.9) | 1.241 | 0.834–1.846 | 0.280 |
Clinical manifestations | |||||
Initial altered consciousness | 32 (91.4) | 31 (91.2) | 1.003 | 0.867–1.160 | 0.970 |
Fever | 29 (82.9) | 30 (88.2) | 0.939 | 0.773–1.140 | 0.526 |
Seizure | 15 (42.9) | 17 (50.0) | 0.857 | 0.515–1.426 | 0.552 |
Septic shock | 18 (51.4) | 10 (29.4) | 1.749 | 0.948–3.2251 | 0.063 |
Hyponatremia | 6 (17.1) | 10 (29.4) | 0.583 | 0.238–1.427 | 0.227 |
Hydrocephalus | 8 (22.9) | 7 (20.6) | 1.110 | 0.452–2.725 | 0.819 |
DKA/HHS | 5 (14.3) | 9 (26.5) | 0.540 | 0.201–1.447 | 0.208 |
Brain abscess | 4 (11.4) | 7 (20.6) | 0.555 | 0.179–1.726 | 0.299 |
Ischemic infarct | 4 (11.4) | 7 (20.6) | 0.555 | 0.179–1.726 | 0.299 |
Vasculitis | 3 (8.6) | 4 (11.8) | 0.729 | 0.176–3.016 | 0.660 |
Liver abscess | 3 (8.6) | 3 (8.8) | 0.971 | 0.211–4.482 | 0.970 |
Infective endocarditis | 1 (2.9) | 1 (2.9) | 0.971 | 0.063-14.9151 | 0.983 |
Bacteremia | 20 (57.1) | 17 (50.0) | 1.143 | 0.735–1.778 | 0.552 |
K. pneumoniae infection | 22 (62.9) | 11 (32.4) | 1.943 | 1.122–3.363 | 0.011* |
Cerebrospinal fluid | |||||
Median (IQR) Glucose level (mmol/L) | 1.64 (0.28, 3.97) | 1.67 (0.28, 6.60) | 0.211 | ||
Median (IQR) Total protein level (g/L) | 4.95 (2.71, 8.32) | 6.15 (2.01, 7.69) | 0.893 | ||
Median (IQR) Lactate level (mmol/L) | 14.65 (7.22, 18.87) | 13.54 (8.66, 17.76) | 0.673 | ||
Median (IQR) WBC counts (109/L) | 0.60 (0.28, 4.26) | 1.25 (0.20, 6.67) | 0.287 |
Characteristic | ≤ 72 h N = 13 (%) | > 72 h N = 22 (%) | ORa | 95% CIa | p-value | ORb | 95% CIb | Adjusted p-value |
---|---|---|---|---|---|---|---|---|
Age | 62.31 ± 14.55 | 59.18 ± 13.19 | 0.519 | |||||
Gender | ||||||||
Male | 10 (76.9) | 13 (59.1) | 0.433 | 0.092–2.031 | 0.283 | |||
Female | 3 (23.1) | 9 (40.9) | ||||||
Initial consciousness level (Glasgow coma scale) | 5.69 ± 2.10 | 5.73 ± 1.88 | 0.960 | |||||
Inappropriate antibiotics use | 5 (38.5) | 7 (31.8) | 1.862 | 0.203-2.600 | 0.840 | |||
Underlying condition | ||||||||
Diabetes mellitus | 6 (46.2) | 8 (36.4) | 1.269 | 0.567–2.843 | 0.568 | |||
Alcoholism | 4 (30.8) | 6 (27.3) | 1.128 | 0.390–3.267 | 0.825 | |||
Liver cirrhosis | 2 (15.4) | 7 (31.8) | 0.484 | 0.118–1.988 | 0.282 | |||
Systemic malignancy | 2 (15.4) | 2 (9.1) | 1.692 | 0.270-10.614 | 0.572 | |||
Intracranial hemorrhage | 1 (7.7) | 3 (13.6) | 0.564 | 0.065–4.876 | 0.593 | |||
End-stage renal disease | 0 (0.0) | 6 (27.3) | 0.729 | 0.563–0.939 | 0.039* | - | - | 0.999 |
Substance abuser | 0 (0.0) | 2 (9.1) | 0.909 | 0.797–1.037 | 0.263 | |||
Immunocompromised state | 8 (61.5) | 15 (68.2) | 0.903 | 0.539–1.512 | 0.689 | |||
Clinical manifestations | ||||||||
Fever | 10 (76.9) | 19 (86.4) | 0.891 | 0.633–1.253 | 0.474 | |||
Septic shock | 7 (53.8) | 11 (50.0) | 1.077 | 0.560–2.071 | 0.8261 | |||
Seizure | 6 (46.2) | 9 (40.9) | 1.128 | 0.521–2.4432 | 0.762 | |||
Hydrocephalus | 2 (15.4) | 6 (27.3) | 0.564 | 0.133–2.395 | 0.418 | |||
DKA/HHS | 4 (30.1) | 1 (4.5) | 6.769 | 1.845–54.253 | 0.032* | - | - | 0.112 |
Hyponatremia | 3 (23.1) | 3 (13.6) | 1.692 | 0.399–7.186 | 0.474 | |||
Brain abscess | 1 (7.7) | 3 (13.6) | 0.564 | 0.065–4.876 | 0.593 | |||
Ischemic infarct | 2 (15.4) | 2 (9.1) | 1.692 | 0.270-10.614 | 0.572 | |||
Liver abscess | 1 (7.7) | 2 (9.1) | 0.846 | 0.085–8.444 | 0.886 | |||
Vasculitis | 1 (7.7) | 2 (9.1) | 0.846 | 0.085–8.444 | 0.886 | |||
Bacteremia | 9 (69.2) | 11 (50.0) | 1.385 | 0.796–2.407 | 0.267 | |||
K. pneumoniae infection | 11 (84.6) | 11 (50.0) | 5.000 | 0.884–28.288 | 0.056 | |||
Cerebrospinal fluid | ||||||||
Median (IQR) Glucose level (mmol/L) | 2.69 (0.76, 5.67) | 0.44 (0.28, 3.89) | 0.114 | |||||
Median (IQR) Total protein level (g/L) | 7.13 (2.60, 1.17) | 4.64 (2.04, 7.72) | 0.146 | |||||
Median (IQR) Lactate level (mmol/L) | 17.76 (11.29, 22.76) | 12.32 (5.86, 17.59) | 0.089 | |||||
Median (IQR) WBC counts (109/L) | 0.60 (0.33, 4.41) | 1.47 (0.27, 5.37) | 0.332 |