Using the NESI (Neisseria sepsis index) score in acute meningococcaemia

Abstract

Introduction: Meningococcal infection may present as meningitis or as fulminant septic shock. Different prognostic scoring systems have been developed in order to classify patients according to their expected outcome. The NESI score was designed using laboratory and clinical parameters. Objective: We measured the prognostical role of this index in paedriatric patients and compared it to the risk of death. Method: This was a prospective study, used in patients admitted to the PICU in the hospitals Sótero del Río and Padre Hurtado with meningococcal infection between december 1995 and december 1999. NESI considers heart rate (HR), mean arterial blood pressure (MAP), base excess (BE) and progression of cutaneous lesions (CL). We noted some biochemical characteristics and the final outcome. Results: 121 consecutive cases of meningococcal infection were admitted. Neisseria meningitidis was cultured in 74 (61%). Patients were aged between 1 and 156 months (median 41), 58% were male. Eleven patients (9%) died owing to multiorgan failure. There were no statistical differences in mortality by age, sex or the presence of meningitis. Half of the patients had a NESI score of 2. Patients with a score of 3 or more had almost 4 times the risk of death (RR = 4.96, p < 0.01) as compared with those with a lesser score. Both sensitivity and negative predictive values were 100%. Conclusion: the fact that the NESI score considers few clinical parameters it might be used in any hospital for early recognition of a life threatening condition in patients with acute meningococcal infection.