Multivariable predictive models for adverse outcome of invasive meningococcal disease in children

doi:10.1016/S0022-3476(96)70153-1

The Journal of Pediatrics

Volume 129, Issue 5, November 1996, Pages 702-710

https://doi.org/10.1016/S0022-3476(96)70153-1 Get rights and content

Abstract

For prediction of adverse outcome (AO, defined as death or limb amputation) of invasive meningococcal disease (IMD) in children, two multivariable models were derived and validated by reviewing the data in the medical records of patients with IMD, who ranged from birth to 19 years of age, at three pediatric referral hospitals between 1985 and 1990 (derivation set, n = 153, 19 AO) and between 1991 and 1994 (validation set, n = 92, 11 AO). Variables in the derivation set significantly associated with AO (p <0.05) were entered into a logistic regression analysis. Because coagulation studies (prothrombin time, partial thromboplastin time, and serum fibrinogen concentration) were available for only 50% of patients, two analyses were performed, either excluding (model 1) or including (model 2) coagulation studies. These analyses identified an absolute neutrophil count less than 3000/mm³, poor perfusion, and a platelet count less than 150,000/mm³ (model 1), and a serum fibrinogen concentration less than 2.5 gm/L (250 mg/dl) and an absolute neutrophil count less than 3000/mm³ (model 2), as independent predictors of AO (p <0.05). When the models were tested on the validation set, the presence of at least two of the three predictors in model 1 had a sensitivity of 82% and a specificity of 97% in predicting AO; the presence of both predictors in model 2 had a sensitivity of 89% and a specificity of 97%. These models can reliably identify patients with IMD at high risk of AO for whom consideration of novel therapies is justified. (J Pediatr 1996;129:702-10)

Section snippets

Population

After institutional approval, we reviewed the medical records of all patients younger than 20 years of age who were admitted to Harbor-University of California at Los Angeles Medical Center, Torrance, and to Children's Hospital, Boston, Mass., with a diagnosis of IMD between January 1985 and October 1990. Cases were identified through bacteriology laboratory records and discharge diagnoses of all patients admitted to these two hospitals during this period. These patients constituted the

Patient characteristics (Table I)

DISCUSSION

We derived and validated two models for the prediction of adverse outcome of IMD in children. The first model included clinical data (perfusion status) and data from a complete blood cell count (ANC, platelet count). These data are readily and almost universally available to the clinician at the time of the initial encounter with the patient. The second model included data from a complete blood cell count (ANC) and the serum fibrinogen concentration. These models should be easy to use because

Acknowledgements

We thank Kathleen Harney, MD, and Nicole Glaser, MD, for their critical review of the manuscript.

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IMD incidence has decreased in our setting, with MenB being the most common serogroup. The higher prevalence of MenC in adults was probably related to lower vaccination coverage. According to this study, thrombocytopenia, leukopenia, and purpuric rash were parameters associated with worse outcome.
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^☆: From the Divisions of Emergency Medicine and Infectious Diseases, Department of Medicine, Children's Hospital and Harvard Medical School, Boston, Massachusetts, and the Division of Emergency Medicine and Department of Pediatrics, University of California, Davis, School of Medicine

^☆☆: Reprint requests: Richard Malley, MD, Division of Emergency Medicine, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.

^★: 0022-3476/96/$5.00 + 0 9/21/75816

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Multivariable predictive models for adverse outcome of invasive meningococcal disease in children☆,☆☆,★

Abstract

Section snippets

Population

Patient characteristics (Table I)

DISCUSSION

Acknowledgements

J Pediatr

J Pediatr

Laboratory-based surveillance for meningococcal disease in selected areas, United States, 1989-1991

MMWR CDC Surveill Summ

Serogroup C meningococcal outbreaks in the United States: an emerging threat

JAMA

Trends in mortality in children hospitalized with meningococcal infections, 1957 to 1987

Pediatr Infect Dis

Meningococcal infections in children: a review of 100 cases

Pediatr Infect Dis

An outbreak of meningococcal disease in Auckland, New Zealand

Pediatr Infect Dis

Meningococcal infections in the Province of Quebec, Canada, during the period 1991 to 1992

J Clin Microbiol

Surgical intervention for the complications of meningococcal-induced purpura fulminans

Pediatr Infect Dis

Meningococcemia and purpura fulminans in adults: acute deficiencies of proteins C and S and early treatment with antithrombin III concentrates

Intensive Care Med

Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin: a randomized, double-blind, placebo-controlled trial: the HA-1A Sepsis Study Group

N Engl J Med

Treatment of septic shock with human monoclonal antibody HA-1A: a randomized, double-blind, placebo-controlled trial: CHESS Trial Study Group

Ann Intern Med

The French National Registry of HA-1A (Centoxin) in septic shock: a cohort study of 600 patients: the National Committee for the Evaluation of Centoxin

Arch Intern Med

A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis: the XOMA Sepsis Study Group

JAMA

Influence of an anti-tumor necrosis factor monoclonal antibody on cytokine levels in patients with sepsis: the CB0006 Sepsis Syndrome Study Group

Crit Care Med

Initial evaluation of human recombinant interleukin-1 receptor antagonist in the treatment of sepsis syndrome: a randomized, open-label, placebo-controlled multicenter trial: the IL-1RA Sepsis Syndrome Study Group

Crit Care Med