Risk scores for outcome in bacterial meningitis: Systematic review and external validation study - 28/10/16

Doi : 10.1016/j.jinf.2016.08.003

Merijn W. Bijlsma ^a, Matthijs C. Brouwer ^a, Patrick M. Bossuyt ^b, Martijn W. Heymans ^e, Arie van der Ende ^c,^d, Michael W.T. Tanck ^b, Diederik van de Beek ^a,^⁎
^a Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^b Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^c Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^d The Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^e Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

^∗Corresponding author. Departments of Neurology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100DD Amsterdam, The Netherlands.Departments of NeurologyAcademic Medical CenterUniversity of AmsterdamPO Box 22660Amsterdam1100DDThe Netherlands

Summary

Objectives

To perform an external validation study of risk scores, identified through a systematic review, predicting outcome in community-acquired bacterial meningitis.

Methods

MEDLINE and EMBASE were searched for articles published between January 1960 and August 2014. Performance was evaluated in 2108 episodes of adult community-acquired bacterial meningitis from two nationwide prospective cohort studies by the area under the receiver operating characteristic curve (AUC), the calibration curve, calibration slope or Hosmer–Lemeshow test, and the distribution of calculated risks.

Findings

Nine risk scores were identified predicting death, neurological deficit or death, or unfavorable outcome at discharge in bacterial meningitis, pneumococcal meningitis and invasive meningococcal disease. Most studies had shortcomings in design, analyses, and reporting. Evaluation showed AUCs of 0.59 (0.57–0.61) and 0.74 (0.71–0.76) in bacterial meningitis, 0.67 (0.64–0.70) in pneumococcal meningitis, and 0.81 (0.73–0.90), 0.82 (0.74–0.91), 0.84 (0.75–0.93), 0.84 (0.76–0.93), 0.85 (0.75–0.95), and 0.90 (0.83–0.98) in meningococcal meningitis. Calibration curves showed adequate agreement between predicted and observed outcomes for four scores, but statistical tests indicated poor calibration of all risk scores.

Interpretation

One score could be recommended for the interpretation and design of bacterial meningitis studies. None of the existing scores performed well enough to recommend routine use in individual patient management.

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Highlights

•	Nine risk scores for outcome in bacterial meningitis were found by systematic review.
•	Scores were subsequently validated in an external nationwide prospective cohort.
•	We recommend one score for the design and interpretation of meningitis studies.
•	No score performed well enough to recommend routine use in patient management.

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Keywords : Meningitis, Bacterial infections, Prognosis, Prediction rules, Risk stratification