Clinical and laboratory predictors of in hospital mortality in adult bacterial meningitis: A tertiary care study from Pakistan.

OBJECTIVE

To determine clinical, laboratory and microbiological factors associated with in-hospital mortality among adults diagnosed with bacterial meningitis in Pakistan and compare these findings with regional and global data.

METHODS

This single-center retrospective cohort study was conducted over a 2-year period. Adult aged > 18 years diagnosed with bacterial meningitis based on clinical and cerebrospinal fluid (CSF) criteria were included. Demographic, clinical, laboratory, and microbiological data were recorded. For predictors of in-hospital mortality, we used logistic regression analysis.

RESULTS

Among 182 patients, the mean age was 42.8 ± 14.6 years; 104 (57.1%) were male. In-hospital mortality was 25.3% (n = 46). CSF cultures were positive in 22.5% (n = 41) with Streptococcus pneumoniae (14.8%) and N. meningitidis (4.4%) being the most common pathogens. In the remaining 77.5%, CSF cultures were either not performed or yielded no growth. Factors independently associated with mortality included, age > 60 years (OR 3.12), GCS ≤ 8 at presentation (OR 5.24), seizures during hospitalization (OR 2.93), and CSF glucose < 2 mmol/L (OR 2.64). Timing of antibiotic administration was excluded due to incomplete documentation.

CONCLUSION

The in-hospital mortality in adult bacterial meningitis remains high in Pakistan. The observed mortality rate and identified predictors were comparable to those reported in regional South Asian studies and international cohorts. Older age, low GCS, seizures, and low CSF glucose are strongly associated with poor outcome.