DEFINITION OF A NEW SCORE FOR SEVERITY OF GENERALIZED NEISSERIA-MENINGITIDIS INFECTION

Neisseria meningitidis infection may present as meningitis or as sever e, fulminant sepsis. In order to classify individual patients early ac cording to the expected course of the disease, we developed a score na med Neisseria sepsis index [NESI]. The NESI was defined using the para meters heart rate, mean arterial blood pressure, base excess and prese nce of acute subcutaneous bleeding and/or skin necroses (minimal value [= no evidence for sepsis] NESI 0; maximum value [= most severe sepsi s] NESI 8), Seventeen patients with documented, systemic N. meningitid is infection were prospectively assessed for the terminal complement c omplex (TCC), serum tumour necrosis factor alpha (TNF alpha) levels (a s laboratory parameters for severity of sepsis) and NEST score. The ev aluation was immediately performed when the patients were admitted to the hospital. The 17 patients showed the following distribution of dat a: NESI 0 (n = 4), NESI 1 (n = 6), NESI 2 (n = 0), NESI 3 (n = 1), NES I 4 (n = 2), NESI 5 (n = 2), NESI 6 (n = 0), NESI 7 (n = 1), NESI 8 (n = 1). Mortality was 4/17 patients, all had NESI greater than or equal to 5. TCC values ranged from 647-6461 ng/ml (normal range: 130-360 ng /ml): and was not correlated to NESI. TNF alpha values ranged from 10- 910 pg/ml and were correlated to NESI (r(2) = 0.71, n = 17, P < 0.001) . In patients with Fatal outcome, TNF alpha was 600 +/- 160 pg/ml (mea n +/- SEM) and in surviving patients 130 +/- 50 pg/ml (mean +/- SEM). TNF alpha was increased in 15/17 patients when compared to normal cont rols (< 27 pg/ml). Conclusion The NESI is bused on few clinical, objec tive data, that are available in every hospital, NESI appears to offer an instrument: (1) for making decisions in regard to appropriate moni toring and treatment of vital organ function; and (2) for assessing th e quality of care for this life-threatening infection.