Analysis of risk factors for poor prognosis in patients with hospital-acquired bacterial meningitis and establishment of nomogram prediction model

doi:10.16150/j.1671-2870.2025.04.011

Abstract

Abstract:

Objective To explore the risk factors for poor prognosis in patients with hospital-acquired bacterial me-ningitis (HABM) and to establish a nomogram model to predict its occurrence. Methods A total of 110 patients with HABM admitted to Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2013 to December 31, 2020 were consecutively enrolled. Based on survival status at discharge, they were divided into a death group (n=22) and a survival group (n=88). Subsequently, 110 patients were randomly divided into a training cohort (n=77) and a validation cohort (n=33). The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to identify risk factors for poor prognosis in patients with HABM. A nomogram model was constructed based on these risk factors. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to evaluate the model discrimination, and the calibration curve was used to evaluate the internal consistency of the model. Results Based on the LASSO regression, seven factors were identified: gram-positive staining of microorga-nisms in cerebro-spinal fluid (CSF) culture, elevated neutrophil count on routine blood tests, elevated procalcitonin, elevated CSF protein, decreased prothrombin time, positive blood culture, and history of lumbar drainage. A nomogram prediction model for poor prognosis in HABM patients was established. The areas under the ROC curves for the training cohort and the validation cohort were 0.931 and 0.862, respectively. The calibration plots demonstrated that the calibration curves showed good agreement with the ideal curves, indicating an excellent goodness of fit. Conclusions The risk factor-based nomogram model established in this study demonstrates good predictability, consistency, and clinical applicability for predicting mortality in hospitalized HABM patients, supporting clinicians in the preliminary assessment of the risk of poor prognosis.

Key words: Meningitis, Risk factor, Prognostic model, Nomogram, Least absolute shrinkage and selection operator regression

CLC Number:

YANG Mei, LIAO Qi'an, TAN Quanhui, LI Tingting, ZHANG Yi, CHEN Jie, TANG Zhenghao. Analysis of risk factors for poor prognosis in patients with hospital-acquired bacterial meningitis and establishment of nomogram prediction model[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(04): 441-448.

Figures/Tables 6

Table 1

Comparison of basic data between the survival group and death group

Characteristics	Death group (n=22)	Survival group (n=88)	P-value	Characteristics	Death group (n=22)	Survival group (n=88)	P value
Age(years)	61 ± 11	55 ± 13	0.057	Antithrombin Ⅲ activity(%)	65 ± 25	89 ± 16	<0.001
Sex(%)			0.483	More than two surgeries(%)			0.212
Female	9 (40.9%)	29 (33.0%)		No	13 (59.1%)	64 (72.7%)
Male	13 (59.1%)	59 (67.0%)		Yes	9 (40.9%)	24 (27.3%)
Admission GCS	7.9 ± 4.0	9.3 ± 3.7	0.073	blood culture（%））			0.001
Gram stain of CSF microbial[n（%）]			0.01	No	11 (50.0%)	73 (83.0%)
Negetive	13 (59.1%)	26 (29.5%)		Yes	11 (50.0%)	15 (17.0%)
Positive	9 (40.9%)	62 (70.5%)		GCS on the day of culture	7.5 ± 3.3	9.4 ± 3.5	0.018
CSF Chloride(mmol/L)	120 ± 17	119 ± 16	0.988	Surgical incision length greater than 10 cm(%)			0.19
CSF Sugar(mmol/L)	2.26 ± 2.13	3.50 ± 2.14	0.02	No	12 (54.5%)	61 (69.3%)
CSF protein(mmol/L)	5.6 ± 5.3	4.2 ± 12.8	0.023	Yes	10 (45.5%)	27 (30.7%)
CSF WBC>10(× 10⁶/L)			0.273	Surgical time greater than 4 h（%）			0.529
<100	12 (54.5%)	59 (67.0%)		No	17 (77.3%)	74 (84.1%)
>100	10 (45.5%)	29 (33.0%)		Yes	5 (22.7%)	14 (15.9%)
CSF RBC[n（%）]			0.775	Tracheal intubation/incision greater than 7 days(%)			0.021
Little	11 (50.0%)	47 (53.4%)		No	3 (13.6%)	35 (39.8%)
Many	11 (50.0%)	41 (46.6%)		Yes	19 (86.4%)	53 (60.2%)
WBC(× 10⁹/L)	14.7 ± 7.2	11.7 ± 5.9	0.07	Fever(%)			0.306
Neutrophil(× 10⁹/L)	12.7 ± 6.7	10.6 ± 15.1	0.037	No	5 (22.7%)	30 (34.1%)
RBC(× 10¹²/L)	3.41 ± 0.57	3.66 ± 0.82	0.199	Yes	17 (77.3%)	58 (65.9%)
PLT(× 10⁹/L)	226 ± 137	278 ± 107	0.019	External ventricular drainage greater than 7 days(%)			0.151
Neutrophil percentage(%)	84 ± 8	77 ± 9	<0.001	No	9 (40.9%)	51 (58.0%)
Lymphocytes(× 10⁹/L)	1.07 ± 0.56	1.31 ± 0.59	0.087	Yes	13 (59.1%)	37 (42.0%)
Monocytes(× 10⁹/L)	0.76 ± 0.42	0.81 ± 0.53	0.994	CSF leakage(%)			0.684
Average platelet volume(fL)	11.41 ± 1.62	10.52 ± 1.09	0.02	No	21 (95.5%)	80 (90.9%)
Platelet mean width(fL)	15.19 ± 3.80	13.77 ± 11.10	0.005	Yes	1 (4.5%)	8 (9.1%)
Plateletcrit(%)	0.25 ± 0.13	0.29 ± 0.11	0.087	Extraspinal diversion(%)			0.049
Albumin (g/L)	33.2 ± 5.3	36.3 ± 4.8	0.002	No	18 (81.8%)	84 (95.5%)
Albumin to globulin ratio	1.48 ± 0.41	1.51 ± 0.36	0.403	Yes	4 (18.2%)	4 (4.5%)
CRP（mg/L）	79 ± 38	56 ± 47	0.003	V-P shunting(%)			0.755
Procalcitonin（ng/mL）	1.40 ± 1.83	0.32 ± 0.38	<0.001	No	18 (81.8%)	74 (84.1%)
D-D（mg/L）	4.1 ± 4.3	4.1 ± 4.1	0.799	Yes	4 (18.2%)	14 (15.9%)
PT(s)	14.19 ± 2.06	12.26 ± 1.31	<0.001	Diplopneumonia(%)			0.09
INR	1.69 ± 2.10	1.07 ± 0.12	<0.001	No	3 (13.6%)	28 (31.8%)
APTT（s）	38 ± 15	29 ± 7	0.003	Yes	19 (86.4%)	60 (68.2%)
Fibrinogen(g/L)	3.97 ± 1.54	4.00 ± 2.14	0.893	Deep vein cannulation(%)			0.017
Prothrombin time（s）	16.84 ± 2.28	16.30 ± 1.85	0.168	No	2 (9.1%)	31 (35.2%)
FDP(mg/L)	13 ± 12	13 ± 11	0.751	Yes	20 (90.9%)	57 (64.8%)

Table 1

Table 2

Comparison of clinical data of Training cohort and Internal test cohort

Characteristic	Cohort		P-value	Characteristic	Cohort		P value
Characteristic	Training Cohort (n=77)	Internal Test Cohort (n=33)	P-value	Characteristic	Training Cohort (n=77)	Internal Test Cohort (n=33)	P value
Age(years)	57 ± 12	55 ± 14	0.524	Extraspinal diversion(%)			0.431
Sex(%)			0.861	No	70 (90.9%)	32 (97.0%)
Female	27 (35.1%)	11 (33.3%)		Yes	7 (9.1%)	1 (3.0%)
Male	50 (64.9%)	22 (66.7%)		CSF leakage(%)			0.448
Gram stain of CSF microbial			0.317	No	72 (93.5%)	29 (87.9%)
Negetive	25 (32.5%)	14 (42.4%)		Yes	5 (6.5%)	4 (12.1%)
Positive	52 (67.5%)	19 (57.6%)		V-P shunting(%)			0.043
CSF Chloride(mmol/L)	119 ± 18	119 ± 12	0.834	No	68 (88.3%)	24 (72.7%)
CSF Sugar(mmol/L)	3.55 ± 2.33	2.56 ± 1.64	0.013	Yes	9 (11.7%)	9 (27.3%)
CSF protein(mmol/L)	5.0 ± 13.7	3.3 ± 3.6	0.32	Diplopneumonia(%)			0.432
CSF RBC(%)			0.56	No	20 (26.0%)	11 (33.3%)
Little	42 (54.5%)	16 (48.5%)		Yes	57 (74.0%)	22 (66.7%)
Many	35 (45.5%)	17 (51.5%)		Deep vein cannulation(%)			0.159
CSF WBC(× 10⁶/L)			0.896	No	20 (26.0%)	13 (39.4%)
<100	50 (64.9%)	21 (63.6%)		Yes	57 (74.0%)	20 (60.6%)
>100	27 (35.1%)	12 (36.4%)		WBC(× 10⁹/L)	13.1 ± 6.6	10.5 ± 5.3	0.033
Admission GCS	9.1 ± 3.8	8.9 ± 3.7	0.786	Neutrophil(× 10⁹/L)	12.2 ± 16.2	8.3 ± 4.6	0.053
Blood culture(%)			0.281	Neutrophil percentage(%)	78 ± 10	78 ± 7	0.626
Negetive	61 (79.2%)	23 (69.7%)		Monocytes(× 10⁹/L)	0.84 ± 0.54	0.71 ± 0.43	0.175
Positive	16 (20.8%)	10 (30.3%)		Lymphocytes(× 10⁹/L)	1.27 ± 0.59	1.27 ± 0.59	0.998
More than two surge-ries(%)			0.159	PLT(× 10⁹/L)	243 ± 117	240± 120	0.164
No	57 (74.0%)	20 (60.6%)		Plateletcrit(%)	0.26 ± 0.12	0.30 ± 0.15	0.876
Yes	20 (26.0%)	13 (39.4%)		Albumin to globulin ratio	11.39 ± 1.6	10.59 ± 1.15	0.335
GCS on the day of culture	8.9 ± 3.5	9.2 ± 3.5	0.723	CRP（mg/L）	81 ± 41	82 ± 23	0.445
Surgical incision length greater than 10 cm(%)			0.692	Procalcitonin（ng/mL）	0.92 ± 0.8	1.2 ± 0.9	0.126
No	52 (67.5%)	21 (63.6%)		Average platelet volume(fL)	10.82 ± 1.24	10.41 ± 1.26	0.118
Yes	25 (32.5%)	12 (36.4%)		Platelet mean width(fL)	13.23 ± 2.84	15.96 ± 17.91	0.391
Surgical time greater than 4 h			0.7	RBC(× 10¹²/L)	3.66 ± 0.85	3.48 ± 0.57	0.205
No(%)	63 (81.8%)	28 (84.8%)		Albumin (g/L)	35.5 ± 4.9	36.2 ± 5.3	0.534
Yes	14 (18.2%)	5 (15.2%)		Fibrinogen(g/L)	4.09 ± 2.17	3.77 ± 1.68	0.405
Tracheal intubation/ incision greater than 7 days(%)			0.793	APPT(s)	30 ± 10	31 ± 10	0.669
No	26 (33.8%)	12 (36.4%)		INR	1.23 ± 1.14	1.11 ± 0.15	0.376
Yes	51 (66.2%)	21 (63.6%)		Prothrombin time(s)	12.59 ± 1.65	12.78 ± 1.74	0.596
Fever(%)			0.823	D-D(mg/L)	4.2 ± 4.3	4.1 ± 3.7	0.908
No	25 (32.5%)	10 (30.3%)		PT(s)	16.24 ± 1.72	16.80 ± 2.36	0.228
Yes	52 (67.5%)	23 (69.7%)		FDP(mg/L)	13 ± 12	14 ± 10	0.91
External ventricular drainage greater than 7 days(%)			>0.999	Antithrombin Ⅲ activity(%)	86 ± 19	80 ± 23	0.226
No	42 (54.5%)	18 (54.5%)		Proealeitonin(ng/mL)	275 ± 119	252 ± 105	0.332
Yes	35 (45.5%)	15 (45.5%)

Table 2

Figure 1

Table 3

Figure 2

Figure 3

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