Fatal course in severe meningococcemia: Clinical predictors and effect of transfusion therapy

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Objective:To investigate whether the administration of fresh-frozen plasma to patients with systemic meningococcal disease is associated with an increased mortality rate compared with the administration of plasma substitutes.Design:Seventeen-year case-control study.Setting:Intensive care units and departments of internal medicine and pediatrics of one university hospital and one local hospital.Patients:A total of 336 patients with cultureproven meningococcemia or symptoms characteristic of meningococcemia who were admitted to two hospitals in northern Norway between 1974 and 1991.Measurements and Main Results:High-risk patients were selected on the basis of two different scoring systems (Niklasson's score and clinical score) and classified according to the type of intravenous fluid regimen (fresh-frozen plasma, blood, or colloids). For comparison between groups, analysis of variance and chi-square tests were used. Assessments of adjusted effects on mortality rate were done by multiple logistic regression. Administration of blood or plasma was significantly associated with a fatal course, both in the total patient population (p < .01) and in the high-risk group (p = .02), while using colloids alone was negatively associated with death, although not reaching statistical significance. A significantly lower mortality rate was found in one of the hospitals where colloids were used instead of plasma or blood in the last part of the period studied (p < .05).Conclusion:The results support our hypothesis that the use of fresh-frozen plasma may negatively influence outcome in systemic meningococcal disease. (Crit Care Med 1993; 21:1699–1705)

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