Fatores prognósticos de letalidade nas meningites bacterianas em crianças menores de dois anos

Objetivo: analisar a taxa de letalidade e os fatores prognosticos, observados em ate 24 horas da admissao hospitalar, relacionados ao obito nas meningites bacterianas (MB), em criancas menores de dois anos. Metodo: estudo descritivo analitico, de serie consecutiva de 437 casos de meningite bacteriana em criancas de um ate vinte e quatro meses de idade - excluido o periodo neonatal, internados em hospital universitario de referencia, localizado na Amazonia Oriental, Brasil. Vinte e dois provaveis fatores prognosticos de letalidade foram avaliados, inicialmente, atraves da analise univariada, seguida da analise multivariada – regressao logistica multipla metodo de “stepwise” com IC=95%. Foram utilizados programas de computacao Microsoft Excel 2000 e SPSS 8.0. Resultados: a taxa de letalidade global no periodo foi de 14,6% e o agente etiologico que, individualmente, apresentou maior taxa de letalidade foi o Streptococcus pneumoniae (32,4%). A analise univariada identificou doze fatores, estatisticamente, significantes. A etapa final da regressao logistica multipla evidenciou por ordem decrescente de importância: choque septico (p Purpose: to evaluate rate of lethality and prognostic factors of death in the bacterial meningitis in children under two years of age. Methods: study of analysis, from January 1995 to December 2000, 437 consecutive cases of confirmed diagnosis of bacterial meningitis at University Hospital Joao de Barros Barreto from Brazil - Amazonian Oriental, using computer program SPSS 8.0 for Windows, initially the variables epidemiological, laboratorial and clinical were evaluated by univariate analysis and after through multivariate analysis – logistic regression (stepwise) CI=95%. Results: rate of lethality from 14,6%; based on univariate analysis 12 variables were associated with the adverse outcome: etiology identificated (the pneumococcal presented poor rate of lethality - 32,4%), several malnutrish, coma, seizures, several seizures, focal signals, neurological complications, hemorragical diatesis, skeptical shock, pneumoniae, cerebrospinal fluid glucose level ( 200mg/dL), initial antibiotic; to initial logistic regression (423 valid cases, excluded cases with missing valor) – several seizures, neurological complications, septic shock, cerebrospinal fluid protein level (>200mg/dL), initial antibiotic (protection factor). Only three factors were independently associated with in-hospital mortality. Conclusions: rate of lethality global from 14,6%; the factors of higher predictive power in lower order: shock (hazard ratio=19,60%, confidence interval 8.25-46.58), severe seizures (hazard ratio=17,95%, confidence interval 7.33-43.91) and neurological complications (hazard ratio=3,98%, confidence interval 1.65-9.59).