Patients:
(1) Adults in intensive care units, mostly in France, with overwhelming meningococcal purpura
(2) Patient ages were >= 13 years of age.
Overwhelming meningococcal purpura (Waterhouse-Friderichsen Syndrome) criteria:
(1) meningococcal infection with positive blood and/or CSF cultures
(2) circulatory shock with systolic blood pressure < 90 mm Hg, tachycardia and clinical signs of tissue hypoperfusion (cyanosis, oliguria, cold extremities, mental status changes)
(3) generalized purpuric and/or ecchymotic lesions of abrupt onset (within 12 hours)
Prognostic factors at admission associated with fatal outcome based on univariate analysis:
(1) plasma fibrinogen level <= 1.5 g/L
(2) Factor V concentration of <= 20% of normal activity
(3) platelet count < 80 * 10^9/L
(4) CSF WBC count <= 20 * 10^6/L
Strepwise regression analysis shows that a low fibrinogen level at the time of admission identifies patients at high risk of mortality and morbidity.
