Fatal course in severe meningococcemia: clinical predictors and effect of transfusion therapy
Busund, R.; Straume, B.; Revhaug, A.
Critical Care Medicine 21(11): 1699-1705
1993
ISSN/ISBN: 0090-3493 PMID: 8222686 Document Number: 409204
Objective: To investigate whether the administration of fresh-frozen plasma to patients with systemic meningococcal disease is associated with an increased mortality rate compared with the administration of plasma substitutes. Design: Seventeen-year case-control study. Setting: Intensive care units and departments of internal medicine and pediatrics of one university hospital and one local hospital. Patients: A total of 336 patients with culture-proven meningococcemia or symptoms characteristic of meningococcemia who were admitted to two hospitals in northern Norway between 1974 and 1991. Measurements and Main Results: High-risk patients were selected on the basis of two different scoring systems. (Niklasson's score and clinical score) and classified according to the type of intravenous fluid regimen (fresh-frozen plasma, blood, or colloids). For comparison between groups, analysis of variance and chi-square tests were used. Assessments of adjusted effects on mortality rate were done by multiple logistic regression. Administration of blood or plasma was significantly associated with a fatal course, both in the total patient population (p lt .01) and in the high-risk group (p = .02), while using colloids alone was negatively associated with death, although not reaching statistical significance. A significantly lower mortality rate was found in one of the hospitals where colloids were used instead of plasma or blood in the last part of the period studied (p lt .05). Conclusion: The results support our hypothesis that the use of fresh-frozen plasma may negatively influence outcome in systemic meningococcal disease.