Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance.
Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance.
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DOI：
10.1016/j.ijid.2015.08.001
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发表时间：
2015-10
期刊：
影响因子：
--
通讯作者：
Hasbun R
中科院分区：
文献类型：
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作者：
Shrikanth V;Salazar L;Khoury N;Wootton S;Hasbun R
低血糖（CSF葡萄糖<45 mg/dL）已被确定为脑膜炎患者的预后因素。分析低血糖症的鉴别诊断及其临床意义。回顾性研究了2005年1月至2010年12月在德克萨斯州休斯顿市8家纪念赫尔曼医院接受治疗的620例社区获得性脑膜炎[CSF WBC >5个细胞/mm 3，无CSF分流或近期神经外科手术（< 1个月）]成人患者。不良临床结局定义为格拉斯哥结局量表为4或更低。在620例脑膜炎患者中，116例（19%）有低血糖。低糖血症的病因包括特发性（40例）、细菌性（27例）、隐球菌性（26例）、病毒性（15例）和结核性（4例）。与无低糖血症的患者相比，低糖血症患者更可能出现免疫抑制，有静脉注射药物史，并表现为水疱或点状皮疹，恶心或呕吐，颈项强直，鼻窦炎/中耳炎，精神状态异常和局灶性神经功能缺损（p<0.05）。此外，低糖血症组患者的脑脊液和血培养阳性率、紧急可治疗情况和头颅影像学异常率显著较高（p<0.05）。此外，低糖血症患者有更多不良临床结局[116例中的26例（22.4%）vs. 504例中的45例（8.9%）]（p< 0.001）。低糖血症在评估社区获得性脑膜炎成人患者中具有重要的临床和预后价值。
Hypoglycorrhachia (CSF glucose < 45mg/dL) has been identified as a prognostic factor in patients with meningitis. We analyzed the differential diagnosis of hypoglycorrhachia and its clinical significance. Retrospective study of 620 adult patients with community acquired meningitis [CSF WBC >5 cells/mm3, absence of a CSF shunt or recent neurosurgical procedure (< 1 month)] at 8 Memorial Hermann Hospitals in Houston, TX from January, 2005 to December, 2010. An adverse clinical outcome was defined as a Glasgow outcome scale of 4 or less. Out of 620 patients with meningitis, 116 (19%) had hypoglycorrachia. Etiologies of hypoglycorrhachia were idiopathic (40), bacterial (27), cryptococcal (26), viral (15), and tuberculous (4). Patients with hypoglycorrachia were more likely to be immunosuppressed, have a history of intravenous drug use, and present with a vesicular or petechial rash, nausea or vomiting, nuchal rigidity, sinusitis/otitis, abnormal mental status and focal neurological deficits compared to those patients without hypoglycorrachia (p<0.05). Additionally, patients in the hypoglycorrhachia group had significantly higher rates of positive CSF and blood cultures, urgent treatable conditions and abnormal cranial imaging (p<005). Furthermore, patients with hypoglycorrachia had more adverse clinical outcomes [26 out of 116 (22.4%) vs. 45 out of 504 (8.9%)] (p< 0.001). Hypoglycorrhachia has significant clinical and prognostic value in the evaluation of adult patients with community-acquired meningitis.