Nitric oxide production in meningococcal disease is directly related to disease severity

Objectives: Meningococcal disease is a homogeneous and well-characterized f orm of sepsis. Cardiovascular collapse is prominent in severe meningococcal disease. Nitric oxide overproduction may be a mediator of cardiovascular c ollapse. We relate the level of nitric oxide metabolites, nitrates and nitr ites, to disease severity in meningococcal disease. Design: Prospective, nonrandomized study. Setting: Tertiary referral pediatric intensive care unit. Patients: Children admitted with a clinical diagnosis of meningococcal dise ase. Interventions.. Blood was sampled from children with meningococcal disease. Disease severity was scored using the Glasgow meningococcal septicemia pro gnostic score and pediatric risk of mortality score. Plasma nitrates and ni trites were measured in stored plasma using the Greiss reaction after conve rsion of all the nitrate to nitrite. Measurements and Main Results: Twenty-two children were studied. In 19, the final diagnosis was meningococcal disease. Of the 19 children with meningo coccal disease, 7 had a Glasgow meningococcal septicemia prognostic score o f <8 (mild) and 12 had a Glasgow meningococcal septicemia prognostic score greater than or equal to 8 (severe). Three children died, all of these bein g in the severely affected group. Higher levels of nitrates and nitrites we re seen in the more severely affected children (median admission nitrates a nd nitrites, 27.5 vs. 59.7 nmol/mL; p = 0.063; median peak nitrates and nit rites, 49.9 vs. 114 nmol/mL; p = .01) or those with an increased predicted mortality using pediatric risk of mortality (Spearman's rho 0.742; p = .000 3). Conclusions: Higher levels of nitrates and nitrites are seen in sicker chil dren with meningococcal disease.