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Int J Clin Exp Med. 2015 Mar 15;8(3):4487-93. eCollection 2015.

Prognostic factors of tuberculous meningitis: a single-center study.

Author information

1
Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine Shanghai 200433, China.

Abstract

OBJECTIVE:

To investigate the prognostic factors of tuberculous meningitis (TBM) and develop strategies for the improvement of clinical efficacy.

METHODS:

A total of 156 TBM patients were retrospectively reviewed. The demographic characteristics, underlying diseases, clinical features, laboratory findings, bacteriologic test, images, use of steroids, mannitol and anti-TB drugs, surgery or drainage, and clinical outcomes were collected and analyzed.

RESULTS:

Patients with tubercle bacillus in the cerebrospinal fluid had significantly higher rate of consciousness disturbance (78.8%) and greater proportion of Glasgow coma scale (GCS) score of 3 (37.9%) when compared with the possible TBM patients (51.1% and 13.3%, respectively). Patients with definite TBM had a poor outcome and their mortality was significantly higher than in possible TBM patients (42.4% vs. 17.8%, P < 0.05). Univariate regression analysis showed that the advanced age, concomitant hematogenous disseminated pulmonary tuberculosis, change in consciousness, low GCS score on admission and hydrocephalus were associated with a poor prognosis; timely anti-TB treatment and reasonable hormone applications predicted a favorable outcome. Multivariate regression analysis showed that advanced age, change in consciousness, low GSC score and concomitant hydrocephalus were independent risk factors of TBM, and use of prednisone at ≥ 60 mg/d was protective factor for TBM (P=0.003, OR=0.013).

CONCLUSIONS:

The advanced age, changes in consciousness, low GCS score on admission and concomitant hydrocephalus are independent risk factors of TBM. For patients with risk factors, diagnostic anti-TB therapy and reasonable hormone therapy should be performed timely to reduce mortality and disability.

KEYWORDS:

Tuberculous meningitis; prognosis; prognostic factors

PMID:
26064373
PMCID:
PMC4443207

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