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

YANG Mei, LIAO Qi'an, TAN Quanhui, LI Tingting, ZHANG Yi, CHEN Jie, TANG Zhenghao

Journal of Diagnostics Concepts & Practice 2025, 24 (04): 441-448. DOI: 10.16150/j.1671-2870.2025.04.011

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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.

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%)

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

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

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%)

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%)

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

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

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

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

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

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

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

2 (9.1%)

31 (35.2%)

FDP(mg/L)

13 ± 12

13 ± 11

0.751

Yes

20 (90.9%)

57 (64.8%)