Prognostic factors in ICU patients with community-acquired bacterial meningitis: A post hoc analysis of a multicenter prospective cohort study
16 affiliations
- 1Unité de Médecine Intensive et Réanimation Polyvalente, CHU Reims, Reims, France
- 2Centre d’Investigation Clinique, Hôpital Bichat Claude Bernard, Paris, France
- 3Medical Intensive Care Unit, Normandie Université, UNIROUEN, UR 3830, CHU Rouen, Rouen, France
- 4Critical Care Unit, University Teaching Hospital of Purpan, Toulouse, France
- 5Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Chemin Chauvel, Les Abymes, Guadeloupe, France
- 6Medical Intensive Care Unit, University Hospital of Rennes, Rennes, France
- 7Service de Médecine Intensive Réanimation, CHU de Nice, Nice, France
- 8Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- 9Service de Médecine Intensive Réanimation, Université Clermont-Auvergne, Clermont-Ferrand, France
- 10Médecine Intensive Réanimation, APHP, Centre Université Paris Cité, Cochin Hospital, Paris, France
- 11Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire Dijon, Dijon, France
- 12Nantes University, Nantes University Hospital, Medecine Intensive Reanimation, Nantes, France
- 13Virology Laboratory, CHU Poitiers, Poitiers, France
- 14Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France
- 15Service de Réanimation Médicale GHRMSA, Mulhouse, France
- 16Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
Abstract
Background: Community-acquired adult bacterial meningitis (CABM) is a severe condition associated with significant morbidity and mortality, particularly in patients requiring intensive care unit (ICU) admission. Previous studies have identified several risk factors for poor outcomes, including advanced age, immunosuppression, and delayed treatment. However, data on ICU-specific prognostic factors remain limited. This study aimed to identify factors associated with ICU admission, predictors of 30-day mortality, and long-term outcomes in ICU-admitted patients with CABM.
Methods: This post hoc analysis utilized data from 27 ICUs from the COMBAT cohort, a prospective multicenter study in France from February 2013 to July 2015. The study included patients over 18 years old with confirmed CABM. Clinical, microbiological, and ICU-specific data, including Sequential Organ Failure Assessment (SOFA) scores, were collected. The primary outcome was 30-day mortality, and secondary outcomes included ICU admission predictors and 12-month functional status. Multivariable logistic regression models with pre-specified clinically relevant variables were used to identify factors associated with 30-day mortality and ICU admission; model performance was assessed using the c-statistic and Hosmer–Lemeshow goodness-of-fit test.
Results: Of the 210 patients admitted to the ICU, 36 (17.1%) died within 30 days. Significant predictors of mortality included elevated SOFA scores at ICU admission and on day 3 in univariate and multivariate analyses. Age and non-meningococcal CABM were associated with mortality in the univariate analysis but not in the multivariate analysis. ICU admission was associated with altered consciousness and Neisseria meningitidis CABM according to univariate and multivariate analyses. In multivariable analysis, higher SOFA scores at admission (OR=1.49, 95% CI: 1.28 to 1.74) and on day 3 (OR=1.51, 95% CI: 1.28 to 1.78) were independently associated with 30-day mortality, while altered consciousness (OR=7.51, 95% CI: 4.65 to 15.42) and N. meningitidis identification in cerebrospinal fluid (OR=3.45, 95% CI: 1.15 to 10.00) were independently associated with ICU admission. At 12 months, 51.0% of survivors had poor outcomes on the Glasgow Outcome Scale, with significant neurofunctional impairments observed.
Conclusion: This study identified key prognostic factors for ICU admission and 30-day mortality in CABM patients. Altered consciousness and N. meningitidis infection were associated with ICU admission, whereas elevated SOFA scores at admission and on day 3 were associated with mortality. Despite intensive care, mortality rates remain high, and long-term neurofunctional deficits are common among survivors.
Trial registration: ClinicalTrials.gov identifier NCT01730690.
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BibTeX
@article{noue2026prognostic,
title = {{Prognostic factors in ICU patients with community-acquired bacterial meningitis: A post hoc analysis of a multicenter prospective cohort study}},
author = {Valentin de Villiers de la Noue and Sarah Tubiana and Maryam Rontani and Marion Giry and Benjamine Sarton and Jean-David Pommier and Nicolas Terzi and Mathieu Jozwiak and Laurent Argaud and Claire Dupuis and Nathalie Marin and Jean-Pierre Quenot and Paul Nedelec and Magali Garcia and François Barbier and Khaldoun Kuteifan and Nacim Benchabane and Xavier Duval and Bruno Mourvillier},
journal = {Journal of intensive medicine},
year = {2026},
month = jun,
doi = {10.1016/j.jointm.2026.04.007},
url = {https://europepmc.org/article/PMC/PMC13728389},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prognostic factors in ICU patients with community-acquired bacterial meningitis: A post hoc analysis of a multicenter prospective cohort study
AU - Valentin de Villiers de la Noue
AU - Sarah Tubiana
AU - Maryam Rontani
AU - Marion Giry
AU - Benjamine Sarton
AU - Jean-David Pommier
AU - Nicolas Terzi
AU - Mathieu Jozwiak
AU - Laurent Argaud
AU - Claire Dupuis
AU - Nathalie Marin
AU - Jean-Pierre Quenot
AU - Paul Nedelec
AU - Magali Garcia
AU - François Barbier
AU - Khaldoun Kuteifan
AU - Nacim Benchabane
AU - Xavier Duval
AU - Bruno Mourvillier
PY - 2026
DA - 2026/06/13
JO - Journal of intensive medicine
DO - 10.1016/j.jointm.2026.04.007
UR - https://europepmc.org/article/PMC/PMC13728389
AB - Background: Community-acquired adult bacterial meningitis (CABM) is a severe condition associated with significant morbidity and mortality, particularly in patients requiring intensive care unit (ICU) admission. Previous studies have identified several risk factors for poor outcomes, including advanced age, immunosuppression, and delayed treatment. However, data on ICU-specific prognostic factors remain limited. This study aimed to identify factors associated with ICU admission, predictors of 30-day mortality, and long-term outcomes in ICU-admitted patients with CABM. Methods: This post hoc analysis utilized data from 27 ICUs from the COMBAT cohort, a prospective multicenter study in France from February 2013 to July 2015. The study included patients over 18 years old with confirmed CABM. Clinical, microbiological, and ICU-specific data, including Sequential Organ Failure Assessment (SOFA) scores, were collected. The primary outcome was 30-day mortality, and secondary outcomes included ICU admission predictors and 12-month functional status. Multivariable logistic regression models with pre-specified clinically relevant variables were used to identify factors associated with 30-day mortality and ICU admission; model performance was assessed using the c-statistic and Hosmer–Lemeshow goodness-of-fit test. Results: Of the 210 patients admitted to the ICU, 36 (17.1%) died within 30 days. Significant predictors of mortality included elevated SOFA scores at ICU admission and on day 3 in univariate and multivariate analyses. Age and non-meningococcal CABM were associated with mortality in the univariate analysis but not in the multivariate analysis. ICU admission was associated with altered consciousness and Neisseria meningitidis CABM according to univariate and multivariate analyses. In multivariable analysis, higher SOFA scores at admission (OR=1.49, 95% CI: 1.28 to 1.74) and on day 3 (OR=1.51, 95% CI: 1.28 to 1.78) were independently associated with 30-day mortality, while altered consciousness (OR=7.51, 95% CI: 4.65 to 15.42) and N. meningitidis identification in cerebrospinal fluid (OR=3.45, 95% CI: 1.15 to 10.00) were independently associated with ICU admission. At 12 months, 51.0% of survivors had poor outcomes on the Glasgow Outcome Scale, with significant neurofunctional impairments observed. Conclusion: This study identified key prognostic factors for ICU admission and 30-day mortality in CABM patients. Altered consciousness and N. meningitidis infection were associated with ICU admission, whereas elevated SOFA scores at admission and on day 3 were associated with mortality. Despite intensive care, mortality rates remain high, and long-term neurofunctional deficits are common among survivors. Trial registration: ClinicalTrials.gov identifier NCT01730690.
SN - 2097-0250
SN - 2667-100X
ER -