Chronic alcohol abuse affects the clinical course and outcome of community-acquired bacterial meningitis

Abstract

AbstractBackgroundThe aim of the study was to determine the effect of chronic alcohol abuse on the course and outcome of bacterial meningitis (BM).Materials/methodsWe analyzed records of patients with BM who were hospitalized between January 2010 and December 2017 in the largest neuroinfection center in Poland.Results340 adult patients (211 men and 129 women) were analyzed. Forty-five (13.2%) patients were alcoholics (39 men and 6 women). Compared to non-alcoholics, alcoholics were more likely to present with seizures (33.3% vs 12.6%, p<0.001), scored higher on the Sequential Organ Failure Assessment (SOFA) (median 3 vs 2, p<0.001) and lower on the Glasgow Coma Scale (GCS) (median 10 vs 12, p<0.001) and had worse outcome as measured by the Glasgow Outcome Score (GOS) (median 3 vs 5, p<0.001). Furthermore, alcoholics were less likely to complain of headache (23.3% vs 52.3%, p<0.001) and nausea/vomiting (11.4% vs 33.6%, p=0.005) and had lower concentration of glucose in cerebrospinal fluid (CSF) (median 0,58 mmol/L vs 1,97, p=0.025). In the multiple logistic regression analysis, alcoholism was independently associated with lower GCS (OR 0.716, 95% CI 0.523-0.980, p=0.036), presence of seizures (OR 4.580, 95% CI 1.065-19.706, p=0.041), male gender (OR 4.617, 95% CI 1.060-20.113, p=0.042) and absence of nausea/vomiting (OR 0.205, 95%CI 0.045-0.930, p=0.040). Furthermore, alcoholism (regression coefficient [−0.636], 95% CI [− 1.21] – [−0.06], p=0.031), lower GCS score (regression coefficient 0.144, 95% CI 0.06-0.23, p=0.001) and higher urea blood concentration (regression coefficient [−0.052], 95% CI [−0.10] – [−0.01], p=0.018) were independently associated with worse outcome measured by GOS.ConclusionsCompared to non-alcoholics, chronic alcohol abusers are more likely to present with seizures, altered mental status, higher SOFA score and have an increased risk of unfavorable outcome. In multivariate analysis seizures and low GCS were independently associated with alcoholism, while alcoholism was independently associated with worse outcome.