Prognostic Factors in Meningococcal Disease

A prognostic score in meningococcal disease is suggested, based on the findings in 80 consecutive patients, aged 6 months–67 years. The patients were all treated in the same way in the same hospital during the years 1959–1968. The patients were divided into two clinical groups, predominant meningitis (100 or more WBC/mm3 of cerebrospinal fluid (CSF)) and predominant septicaemia (less than 100 WBC/mm3). The 9 deaths gave an overall fatality rate of 11%. Eight of these occurred in the 15 patients with sepsis (fatality rate 53%) and only 1 in the 65 cases with meningitis (fatality rate 1.5%). All deaths in the sepsis group had a fulminant course with signs of endotoxin shock. Also in the lethal meningitis case the endotoxin shock seemed to be the cause of death. All 80 patients were treated with a combination of penicillin and sulphonamide.Unfavourable prognostic features on admission to hospital were 1) absence of meningitis (less than 100 YVBC mm3 of CSF); 2) presence of low blood pressure (systolic pressure 100 mmHg or less in adults and young people, 70 mmHg or less in children up to 14 years of age); 3) presence of petechiae for less than 12 hours; 4) presence of marked hyperpyrexia (rectal temperature 40°C or above); 5) absence of marked leucocytosis (less than 15 000 WBC/mm3 of blood); and 6) presence of thrombocytopenia (less than 100 000 platelets/mm3 of blood). Eight of the 11 patients with 3 or 4 of the first 4 unfavourable prognostic signs died (fatality rate 73%). With 4 or 5 of the first 5 unfavourable prognostic signs 7 of 8 patients died (fatality rate 88%). All patients with less than 2 prognostic features survived.