Prognostic factors in ICU patients with community-acquired bacterial meningitis: A post hoc analysis of a multicenter prospective cohort study

Background Community-acquired adult bacterial meningitis (CABM) is a severe condition associated with significant morbidity and mortality, particularly in patients requiring intensive care unit (ICU) admission. Previous studies have identified several risk factors for poor outcomes, including advanced age, immunosuppression, and delayed treatment. However, data on ICU-specific prognostic factors remain limited. This study aimed to identify factors associated with ICU admission, predictors of 30-day mortality, and long-term outcomes in ICU-admitted patients with CABM. Methods This post hoc analysis utilized data from 27 ICUs from the COMBAT cohort, a prospective multicenter study in France from February 2013 to July 2015. The study included patients over 18 years old with confirmed CABM. Clinical, microbiological, and ICU-specific data, including Sequential Organ Failure Assessment (SOFA) scores, were collected. The primary outcome was 30-day mortality, and secondary outcomes included ICU admission predictors and 12-month functional status. Multivariable logistic regression models with pre-specified clinically relevant variables were used to identify factors associated with 30-day mortality and ICU admission; model performance was assessed using the c-statistic and Hosmer–Lemeshow goodness-of-fit test. Results Of the 210 patients admitted to the ICU, 36 (17.1%) died within 30 days. Significant predictors of mortality included elevated SOFA scores at ICU admission and on day 3 in univariate and multivariate analyses. Age and non-meningococcal CABM were associated with mortality in the univariate analysis but not in the multivariate analysis. ICU admission was associated with altered consciousness and Neisseria meningitidis CABM according to univariate and multivariate analyses. In multivariable analysis, higher SOFA scores at admission (OR=1.49, 95% CI: 1.28 to 1.74) and on day 3 (OR=1.51, 95% CI: 1.28 to 1.78) were independently associated with 30-day mortality, while altered consciousness (OR=7.51, 95% CI: 4.65 to 15.42) and N. meningitidis identification in cerebrospinal fluid (OR=3.45, 95% CI: 1.15 to 10.00) were independently associated with ICU admission. At 12 months, 51.0% of survivors had poor outcomes on the Glasgow Outcome Scale, with significant neurofunctional impairments observed. Conclusion This study identified key prognostic factors for ICU admission and 30-day mortality in CABM patients. Altered consciousness and N. meningitidis infection were associated with ICU admission, whereas elevated SOFA scores at admission and on day 3 were associated with mortality. Despite intensive care, mortality rates remain high, and long-term neurofunctional deficits are common among survivors. Trial registration ClinicalTrials.gov identifier NCT01730690.