MULTI ORGAN FAILURE IN SEVERE MENINGOCCOCAL
SEPSIS
von Rosenstiel IA, de Neef M, Ramsodit PA, van de
Sande R
Department
of Pediatric Intensive Care, Emma Children’s Hospital, Academic Medical
Center, Amsterdam, The Netherlands
Objective: The aim of this study is
to describe the prevalence and degree of multi organ failure (MOF) in
meningococcal septic shock (MSS).
Methods: Retrospective chart analysis of 105 patients with MSS, divided in
a group with (MSM n=41) and without meningitis (FMS n=64) admitted to the
PICU between Jan. 1993-Dec. 2000. Patients demographics, clinical data,
severity of disease (PRISM, GMSPS), MOF and outcome data were recorded. MOF was assessed by the use of the SOFA-score
(pediatric version).
Results: Overall MOF occurred in 73.4 % of the total cohort with: 2 organ
system failure (OSF) in 21.8 %, 3 OSF in 22.8 % and ³ 4 OSF in 28.8 % of the
patients. The overall mortality in MSS with MOF was 20.3 % compared to 3.7
% in patients without MOF. Leading OSF in decreasing sequence was
cardiovascular failure (92.4 %), respiratory failure (74.7 %), failure of
coagulation (58.1 %), neurological failure (19.8 %) and renal failure (8.8
%). Between the MSM and FMS groups there was a significant difference in
GMSPS (p=<0.001) and PRISM (p=0.006) score (GMSPS: 7.0 vs. 9.8, PRISM:
17.4 vs. 24.4). The total number of organs that failed per patient was
higher in the FMS-group (P=0.048). In the FMS-group the prevalence of MOF
was 75% (48/64) versus 63.4% (26/41) in the MSM-group showing no significant
difference.
Conclusion:
In MSS there is a high prevalence of MOF which severity is strongly
correlated with mortality. The total number of organs failed per patient is
significant higher in the FMS-group.