Pattern, Complications and Short-Term Outcomes of Acute Meningitis
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Background: Acute meningitis remains associated with substantial neurological complications and mortality, while contemporary adult data from tertiary-care settings in Peshawar are limited. Objective: To determine the etiological pattern and major complications of acute meningitis and evaluate short-term in-hospital outcomes and their associations with mortality. Methods: This hospital-based descriptive observational study included 182 consecutive adults aged 20–60 years with acute meningitis diagnosed through cerebrospinal fluid assessment at Khyber Teaching Hospital, Peshawar, from 24 November 2024 to 24 May 2025. Demographic characteristics, meningitis category, altered consciousness, seizures, shock/hypotension, ICU admission, and in-hospital mortality were assessed. Categorical data were summarized as n (%), and crude odds ratios (ORs), 95% confidence intervals (CIs), and exact tests were used for mortality associations. Results: Mean age was 35.4 ± 5.8 years and 68.1% were male. Bacterial, viral, and tuberculous meningitis accounted for 65.9%, 27.5%, and 6.6% of cases, respectively. Altered consciousness occurred in 59.3%, seizures in 50.5%, and shock/hypotension in 13.2%. Overall mortality was 13.2%; case-fatality was 33.3% for tuberculous, 15.8% for bacterial, and 2.0% for viral meningitis. Shock/hypotension had the strongest crude association with mortality (OR 361.67, 95% CI 68.50–1909.62; p<0.001), while altered consciousness, seizures, and ICU admission were also associated with mortality. Conclusion: Bacterial meningitis predominated, while substantial in-hospital mortality was observed. Etiology and markers of systemic and neurological severity were closely associated with short-term outcome
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