Cacaito, thanks. Here is scoring system used in Spain, for prdiction of mortality. Not good to be over 60 and sems like with three strikes one can be batting 100 for the last time.
JAMA Abstracts - August 13, 1997 Editor's Note
Prognostic Factors in Meningococcal Disease
Development of a Bedside Predictive Model and Scoring System
Nicolau Barquet, MD; Pere Domingo, MD; Joan A. Caylà, MD; Julia González, MD; Carlos
Rodrigo, MD; Pedro Fernández-Viladrich, MD; Fernando A. Moraga-Llop, MD; Francesc
Marco, MD; Julio Vázquez, MD; Juan A. Sáez-Nieto, MD; Julio Casal, MD; Jaume Canela,
MD; Marius Foz, MD; for the Barcelona Meningococcal Disease Surveillance Group
Context.—Meningococcal disease is associated with significant morbidity and mortality.
Development of a prognostic model based on clinical findings may be useful for identification
and management of patients with meningococcal infection.
Objectives.—To construct and validate a bedside model and scoring system for prognosis in
meningococcal disease.
Design.—Prospective, population-based study.
Setting.—Twenty-four hospitals in the metropolitan area of Barcelona, Spain.
Patients.—A total of 907 patients with microbiologically proven meningococcal disease.
Patients diagnosed with meningococcal disease from 1987 through 1990 were used to develop
the prognostic model, and those diagnosed in 1991 and 1992 were used to validate it.
Outcome Measures.—Clinical independent prognostic factors for mortality in meningococcal
disease. The association between outcome and independent prognostic factors was determined by
logistic regression analysis. A scoring system was constructed and tested using receiver
operating characteristic curves.
Results.—Among 624 patients in the derivation set, 287 (46%) were male, the mean age was
12.4 years, and 34 patients (5.4%) died. Among 283 patients in the validation set, 124 (43.8%)
were male, the mean age was 12.7 years, and 17 patients (6.0%) died. In multivariate analysis,
independent predictors of death were hemorrhagic diathesis (odds ratio [OR], 101; 95%
confidence interval [CI], 30-333), focal neurologic signs (OR, 25; 95% CI, 7-83), and age 60
years or older (OR, 10; 95% CI, 3-34), whereas receipt of adequate antibiotic therapy prior to
admission was associated with reduced likelihood of death (OR, 0.09; 95% CI, 0.02-0.4).
Hemorrhagic diathesis was scored with 2 points, presence of focal neurologic signs with 1 point,
age of 60 years or older with 1 point, and preadmission antibiotic therapy was scored as -1. The
clinical scores of -1, 0, 1, 2, and 3 or more points were associated with a probability of death of
0%, 2.3%, 27.3%, 73.3%, and 100%, respectively.
Conclusions.—Hemorrhagic diathesis, focal neurologic signs, and age of 60 years or older
were independent predictors of death in meningococcal disease, whereas receipt of adequate
antibiotic therapy was associated with a more favorable prognosis. The scoring system presented
is simple, is based on findings readily available at the bedside, and may be useful to help guide
aggressive therapy.
JAMA. 1997;278:491-496
From the CAP Gràcia, Institut Català de la Salut (Dr Barquet), Hospital de la Santa Creu i Sant
Pau (Dr Domingo), Institut Municipal de la Salut (Dr Caylà), Hospital Clínic (Drs González and
Marco), Hospital Infantil Vall d' Hebron (Dr Moraga-Llop), Departament de Salut Pública i
Legislació Sanitària (Dr Canela), Barcelona; Hospital Germans Trias i Pujol (Drs Rodrigo and
Foz), Badalona; Hospital de Bellvitge (Dr Fernández-Viladrich), L' Hospitalet de Llobregat,
Spain; Laboratorio de Referencia de Meningococos (Drs Vázquez, Sáez-Nieto, and Casal),
Centro Nacional de Microbiología, Virología e Inmunología Sanitarias, Madrid, Spain. A
complete list of the participating centers and other members of the Barcelona Meningococcal
Disease Surveillance Group not listed as authors appears at the end of the article.
EDITOR'S NOTE.—Infection with Neisseria meningitidis is a leading cause of bacteremia and
bacterial meningitis and has the potential to cause overwhelming sepsis and rapid death. In this
study of 907 patients with meningococcal disease, the authors derive and validate a prognostic
model for mortality based on clinical factors readily observable at the patient's bedside. Even
though most of the independent prognostic factors are well recognized, the clinical model may be
useful to help identify patients at highest risk of death from meningococcal disease.
Phil B. Fontanarosa, MD, Senior Editor
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