Predictors of mortality in patients with meningeal tuberculosis

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From: Neurology India(Vol. 60, Issue 1)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 2,350 words
Lexile Measure: 1660L

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Byline: Elizabeth. George, Thomas. Iype, Ajith. Cherian, Sinchu. Chandy, Aswini. Kumar, Ajitha. Balakrishnan, K. Vijayakumar

Background: Meningeal tuberculosis (TB) has higher mortality compared to other forms of central nervous system TB. However, data on predictors of mortality is limited. Aims: To determine the predictors of mortality in patients with meningeal TB. Materials and Methods: This study retrospectively analyzed the data of patients admitted with a diagnosis of meningeal TB between January 2006 and December 2008. Thwaites' index score of four or less was used for the diagnosis of meningeal TB which is a weighted diagnostic index score for dichotomised clinical variables. Predictors of mortality were analyzed separately for both patients with human immunodeficiency virus (HIV) infection and without. Statistical Analysis: Univariate analysis and multinomial logistic regression was done. Results: Univariate analysis showed age >40 years, Glasgow Coma Scale (GCS) score&#8197;<8, absence of headache, cerebrospinal fluid (CSF) protein &#8804;60 mg% and Medical Research Council (MRC) Stage III at presentation to predict in-hospital mortality. In multinomial logistic regression age >40 years was a risk factor for mortality when HIV patients were included (P=0.049) as well as when they were excluded (P=0.048). CSF protein ? 60 mg% was found to be a significant risk factor when both HIV seropositive persons (P=0.011) as well as seronegative persons (P=0.004) were included. HIV seropositivity, steroid treatment or delay in treatment did not affect mortality. Conclusions: Identification of factors predictive of in-hospital mortality will help to prognosticate patients with meningeal TB at the time of admission.

Introduction

Diagnosis, treatment and prognostification of tuberculosis (TB) of the central nervous system (CNS) still pose a formidable challenge and account for about 1% of all cases of TB. Tuberculous meningitis (TBM) is the severest form of CNS TB and is associated with significant morbidity and mortality. Diagnosis of TBM is often based on the clinical features and cerebrospinal fluid (CSF) findings. [sup][1] Early diagnosis is crucial for successful disease management as the case fatality of untreated TBM is almost 100%, and delay in treatment often associated with permanent neurological damage. [sup][2] In a long-term follow-up study of 135 patients with proven meningeal TB on daily directly observed therapy, survival at the end of treatment was 73.3% and 39.76% at the end of 8.71-year mean follow-up. [sup][3] Some of the predictors of mortality included: Age, altered sensorium, underlying comorbidities, and leukocytosis. [sup][4] Admission Glasgow Coma Scale (GCS) score has been shown to predict in-hospital mortality in patients with culture-proven meningeal TB. [sup][5] Delay in the diagnosis is also associated with poor outcome. In a Taiwan study, there was a delay in diagnosis in 47.6% of patients resulting in further progression of the disease stage in 36.2% of patients which was associated with poor outcome. [sup][6] In this study we analyzed the predictors of mortality in patients with meningeal TB.

Materials and Methods

Setting

This retrospective study was undertaken in the Department of Neurology, Government Medical College Hospital, Trivandrum, Kerala, a tertiary care referral centre for neurological diseases in south India. From...

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Gale Document Number: GALE|A284204613