Attenuated cerebrospinal fluid leukocyte count and sepsis in adults with pneumococcal meningitis: a prospective cohort study

Table 1 Multivariate analysis of factors associated a low cerebrospinal fluid leukocyte count*

Characteristics	CSF WBC <1000/mm³(n = 104)	CSF WBC ≥1000/mm³(n = 216)	Odds Ratio (95% CI)†	P-value
Mean age ± SD – years	62 ± 17	57 ± 16	1.22 (1.02–1.45)	0.03‡
Duration of symptoms <24 hr	39/97 (40)	110/200 (55)	1.59 (0.93–2.72)	0.09‡
Immunocompromise§	31 (30)	39/215 (18)	1.74 (0.95–3.18)	0.07‡
Heart rate < 60 beats/min	3/101 (3)	3/202 (1)	3.90 (0.75–20.29)	0.11
Heart rate 60–90 beats/min	26/101 (26)	60/202 (30)	- ¶
Heart rate 90–120 beats/min	45/101 (45)	91/202 (45)	1.00 (0.53–1.89)	0.99
Heart rate >120 beats/min	27/101 (27)	48/202 (24)	1.22(0.52–2.90)	0.65
Diastolic blood pressure <60 mmHg	5/103 (5)	12/209 (6)	0.79 (0.23–2.67)	0.70
Body temperature ≥38°C	84/103 (82)	181/212 (85)	0.59 (0.26–1.29)	0.18
Glasgow Coma Scale score$	11 (8–13)	10 (8–12)	1.08 (0.96–1.20)	0.20
Focal neurologic deficits	47 (45)	93 (43)	1.14 (0.67–1.94)	0.64
CSF protein level – g/L$	3.9 (2.2–6.3)	4.7 (2.9–7.1)	0.94 (0.85–1.03)	0.18
CSF:blood glucose ratio$	0.06 (0.01–0.17)	0.05 (0.01–0.23)	1.08 (0.79–1.49)	0.62
Positive blood culture	72/84 (86)	138/196 (70)	2.46 (1.17–5.14)	0.02‡
ESR – mm/hour$	47 (23–87)	43 (20–71)	1.14 (0.94–1.39)	0.18
Blood WBC <10 – 10⁹/L	22 (21)	16/213 (8)	1.93 (0.90–4.16)	0.09‡
Blood WBC 10–20 – 10⁹/L	51 (49)	109/213 (51)	- ¶
Blood WBC ≥20 – 10⁹/L	31 (30)	88/213 (41)	0.91 (0.49–1.68)	0.76‡
Thrombocyte count – platelet/mm³ $	171,000 (118,000–234,000)	214,000 (175,000–262,000)	0.67 (0.47–0.97)	0.03‡

*Table includes 320 patients in which CSF WBC was determined. Data are given as no. of patients with characteristic/no. evaluated (%) or median (interquartile range), unless indicated otherwise.
†odds ratios are calculated in 10-year increments for age, per increments of 0.2 g/L protein, per 20 mm per hour for ESR, and per 100,000/mm³ for thrombocyte count.
‡significant association in univariate analysis.
§defined as the use of immuno-suppressive drugs, presence of asplenia, diabetes mellitus, alcoholism or infection with the human immunodeficiency virus.
¶this group served as a reference category.
$Glasgow Coma Scale score was obtained in 319 patients, CSF protein level was determined in 300 patients, CSF:blood glucose ratio in 294, ESR in 256, and the thrombocyte count in 295 patients.
CSF, cerebrospinal fluid; WBC, white blood-cell count; ESR, erythrocyte sedimentation rate.

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