Arch Neurosci. 2019 April; 6(2):e86650. Published online 2019 February 24. doi: 10.5812/ans.86650. Research Article Mortality Prediction in Patients with Post-Operative Meningitis: One Longitudinal Study in Iran Arezoo Chouhdari 1, 2 , Mohammadreza Hajiesmaeili 3 , Omidvar Rezaee 1 , Mohammad Samadian 1 , Guive Sharifi 1 , Hossein Pakdaman 2 and Kaveh Ebrahimzadeh 1, * 1 Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3 Anesthesiology Research Center, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran * Corresponding author: Neurosurgery Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Makhsous Ave., South Kargar, Tehran, Iran, Tel: +98-9123047506, Email: dr.kavehebrahimzadeh@gmail.com Received 2018 November 22; Revised 2019 January 16; Accepted 2019 January 23. Abstract Background: Post-operative meningitis(POM) is the important challenge with high mortality in the neurosurgery Objectives: To identify related factors to predict mortality rate of post-operative meningitis. Methods: This descriptive longitudinal study, conducted on patients affected by postoperative meningitis within 30 days after neu- rosurgery from 2017 to 2018, in one subspecialty hospital, Tehran, Iran. Total basic characteristics of patients diagnosed with POM collected and they followed for 30 days. The mortality rate was estimated. For data analysis Chi2 and Fisher exact, so, independent t and Mann-Whitney U, the test used. As well as multivariable logistic regression analysis showed predictor factors of patient’s out- come. Finally, Survival curve was executed by SPSS 19. A significant level was considered P < 0.05 for all tests. Results: In this study, the mortality rate was 5.6 times incidence rate. In multivariable logistic regression analysis, having mechan- ical ventilation (P = 0.03, OR = 1.1, 95%CI= 1.05 - 5.1), length of ICU stays more than 7 days (P = 0.04, OR = 1.2, 95%CI = 0.04 - 6.2), positive cerebrospinal fluid leakage (CSF) culture (P = 0.01, OR = 2.4, 95%CI = 1.9 - 4.08) were forecasting factors to poor outcome. Finally, an inverse relationship between survival function and length of ICU stay in patients affected by postoperative meningitis reported. Conclusions: According to the high rate of mortality and predictor factors in POM, further studies are recommended to find pre- ventive strategies to decrease this dreaded cause of morbidity and mortality in neurosurgical patients. Keywords: Mortality, Prediction, Post-Operative Meningitis, Neurosurgery 1. Background One of the most complications after intra-cranial surgery is meningitis. Post-operative meningitis (POM) is an uncommon (0.3 - 8.1%) but life-threatening compli- cation with high morbidity and sometimes mortality re- ported up to 50% (1-5). Also, postoperative meningitis is associated with prolonged hospitalization, multiple surg- eries, long time antibiotic treatment and increase in to- tal cost of illness (6, 7). It is important to identify risk fac- tors of POM to decline rate of mortality Multiple risk fac- tors have been known, such as postoperative cerebrospinal fluid leakage, concurrent incision infection, CSF shunts, long time operation over 4 hours and emergency surgery (8, 9). As well as set of a foreign body duration surgery, an absence of antibiotic prophylaxis, previous radiation ther- apy, previous neurosurgical infection and interventions on the nasal sinuses have been reported as related factors to POM (8-10). A strong clinical suspicion for meningitis diag- nosis is in patients who have the triad of fever, neck stiff- ness and mental status alteration during the early post- operative period (11, 12) but these signs are nonspecific for diagnosis of post-operative meningitis (13). Analysis of CSF can be helpful for diagnosis of disease but post-operative CSF markers including, glucose, protein, lactate, and cel- lularity also have variation because of manipulating the brain, background brain pathology or bleeding into CSF following the surgery (4, 14). According to the study by Kourbeti et al. in 2015, the incidence rate of post neuro- surgery meningitis has been reported to be about 4.8% and CSF cultures were positive for microbial growth in 100% of these cases. Steroid use, CSF leakage, and ventricular drainage were risk factors to POM mortality (6). In a study by van Aken et al. MO in 2004, post-operative meningitis occurred in 0.7% of patients and all patients underwent the Copyright © 2019, Archives of Neuroscience. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.