Prognostic Factors In Critically Ill Patients With Community-Acquired Acute Bacterial Meningitis And Acute Kidney Injury

Background: Community-acquired bacterial meningitis can present with high mortality, depending on comorbidities and complications, such as acute kidney injury (AKI). The aim of this study was to investigate predictors of poorer outcome in critically ill patients with bacterial meningitis and AKI. Methods & Materials: This is a retrospective study including patients admitted to a tertiary care infectious disease hospital in Fortaleza, Ceará, Brazil, with confirmed diagnosis of community-acquired bacterial meningitis and complicated with AKI. Factors associated with mechanical ventilation and need of vasopressors were investigated, as well as factors associated with death. Results: A total of 41 patients were included, with mean age of 41.6 ± 15.5 years, and 56% were males. Mean time between ICU admission and AKI diagnosis was 5.8 ± 10.6 days. Overall mortality was 53.7%. According to KDIGO criteria, 10 patients were classified as stage 1 (24.4%), 18 as stage 2 (43.9%) and 13 as stage 3 (31.7%). KDIGO 3 significantly increased the risk for death (OR = 6.67, 95% CI = 1.23-36.23, p = 0.028). Thrombocytopenia (platelet count below 150 000/mm3) was not associated with higher mortality, but it was a risk factor for AKI KDIGO 3 (OR = 5.67, 95% CI = 1.25-25.61, p = 0.024) and for requiring mechanical ventilation (OR = 6.25, 95% CI = 1.33-29.37, p = 0.02). Patients who needed invasive mechanical ventilation until 48 hours from AKI diagnosis had higher levels of urea (44.6 vs. 74 mg/dL, p = 0.039) and sodium (138.6 vs. 144.1mEq/L, p = 0.036). Conclusion: Mortality among critically ill patients with community-acquired acute bacterial meningitis who developed AKI is high. AKI severity was associated with even higher mortality. Thrombocytopenia was associated with more severe AKI.