Predictors of outcome in patients with tuberculous meningitis.

Abstract

OBJECTIVE To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM). METHODS Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models. RESULTS Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage II or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multi-variable analysis, convulsion (OR 3.3, 95%CI 1.2-9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6-10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4-11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1-4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4-4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8-22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14-23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04-8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge. CONCLUSION The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.

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@article{Hosoglu2002PredictorsOO, title={Predictors of outcome in patients with tuberculous meningitis.}, author={S Hosoglu and M F Geyik and I Balik and B Aygen and S Erol and T G Aygencel and A Mert and N Saltoglu and I Dokmetas and S Felek and M Sunbul and H Irmak and K Aydin and O F Kokoglu and H Ucmak and M Altindis and M Loeb}, journal={The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease}, year={2002}, volume={6 1}, pages={64-70} }