Bedside Evaluation of Cerebral Energy Metabolism in Severe Community-Acquired Bacterial Meningitis
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ORIGINAL ARTICLE
Bedside Evaluation of Cerebral Energy Metabolism in Severe Community-Acquired Bacterial Meningitis ˚ se B. Andersen • Frantz R. Poulsen • Mette Schulz • Anne Jacobsen • A Lykke Larsen • Wilhelm Schale´n • Troels H. Nielsen • Carl-Henrik Nordstro¨m
Ó Springer Science+Business Media New York 2014
Abstract Background Mortality and morbidity have remained high in bacterial meningitis. Impairment of cerebral energy metabolism probably contributes to unfavorable outcome. Intracerebral microdialysis is routinely used to monitor cerebral energy metabolism, and recent experimental studies indicate that this technique may separate ischemia and nonischemic mitochondrial dysfunction. The present study is a retrospective interpretation of biochemical data obtained in a series of patients with severe community-acquired meningitis. Methods Cerebral energy metabolism was monitored in 15 patients with severe community-acquired meningitis utilizing intracerebral microdialysis and bedside biochemical analysis. According to previous studies, cerebral ischemia was defined as lactate/pyruvate (LP) ratio >30 with intracerebral pyruvate level 30 at a normal or increased interstitial concentration of pyruvate (C70 lmol L-1). Patients with LP-ratios 30) simultaneously with interstitial pyruvate concentration below normal level -2 SD (LP-ratio >30; pyruvate 30) simultaneously with a normal or increased interstitial concentration of pyruvate (pyruvate C70 lmol L-1). The study includes 1,212 microdialysis samples and approximately 6,000 bedside biochemical analyses. Microdialysis with bedside biochemical analysis was performed during altogether 1,090 h (min. 20 h; max. 145 h). Statistical Analysis All values are expressed as median (interquartile rage). Statistical comparison of the median levels of microdialysis variables between the group defined as non-ischemic mitochondrial dysfunction (N = 5) and the group defined as no mitochondrial dysfunction (N = 10) was performed by utilizing the non-parametric Wilcoxon Rank-Sum test. A p value below 0.05 was considered significant. As the p values are to be considered exploratory, no adjustment for generating multiple p values was performed. Stata 11 statistical software package (StataCorp LP, College Station, TX, USA) was used for data analysis.
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Results
of meningitis was delayed for 24 h as the initial clinical picture and CT-scanning was initially interpreted as SAH.
Basic Clinical Data Basic clinical data are presented in Table 1. Median age for the patients included was 26 year (interquartile range 10 and 58 year). In eight of the patients, focal neurological symptoms were observed. One patient of the 15 patients died within 24 h after arrival to the department of neurosurgery. This patient (patient 13) deteriorated rapidly after lumbar puncture in the local hospital, and at arrival to the department of neurosurgery, he was GCS 3 with wide, non-reacting pupils. In addition to the non-surgical therapy described above this, patient was treated with bifr
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