Erdem Hakan, Ozturk-Engin Derya, Tireli Hulya, Kilicoglu Gamze, Defres Sylviane, Gulsun Serda, Sengoz Gonul, Crisan Alexandru, Johansen Isik Somuncu, Inan Asuman, Nechifor Mihai, Al-Mahdawi Akram, Civljak Rok, Ozguler Muge, Savic Branislava, Ceran Nurgul, Cacopardo Bruno, Inal Ayse Seza, Namiduru Mustafa, Dayan Saim, Kayabas Uner, Parlak Emine, Khalifa Ahmad, Kursun Ebru, Sipahi Oguz Resat, Yemisen Mucahit, Akbulut Ayhan, Bitirgen Mehmet, Popovic Natasa, Kandemir Bahar, Luca Catalina, Parlak Mehmet, Stahl Jean Paul, Pehlivanoglu Filiz, Simeon Soline, Ulu-Kilic Aysegul, Yasar Kadriye, Yilmaz Gulden, Yilmaz Emel, Beovic Bojana, Catroux Melanie, Lakatos Botond, Sunbul Mustafa, Oncul Oral, Alabay Selma, Sahin-Horasan Elif, Kose Sukran, Shehata Ghaydaa, Andre Katell, Dragovac Gorana, Gul Hanefi Cem, Karakas Ahmet, Chadapaud Stéphane, Hansmann Yves, Harxhi Arjan, Kirova Valerija, Masse-Chabredier Isabelle, Oncu Serkan, Sener Alper, Tekin Recep, Elaldi Nazif, Deveci Ozcan, Ozkaya Hacer Deniz, Karabay Oguz, Senbayrak Seniha, Agalar Canan, Vahaboglu Haluk
Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey,
J Neurol. 2015;262(4):890-8. doi: 10.1007/s00415-015-7651-5. Epub 2015 Jan 30.
Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16%) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1%, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.
预测不良预后在临床决策中至关重要。因此，我们设计了这项跨国研究，该研究提供了最大规模的结核性脑膜炎（TBM）病例系列。来自14个国家（阿尔巴尼亚、克罗地亚、丹麦、埃及、法国、匈牙利、伊拉克、意大利、马其顿、罗马尼亚、塞尔维亚、斯洛文尼亚、叙利亚、土耳其）的43个中心提交了2000年至2012年间住院的微生物学确诊TBM患者的数据。不良预后定义为存活但有严重后遗症或死亡。在开发我们的指数时，通过自抽样重抽样方法对数据库进行200次重复构建二元逻辑回归模型。最终模型根据变量的选择频率构建。严重程度量表包括与最终模型中各项预测能力成比例的任意分数变量。最终模型通过自抽样重抽样进行内部验证。共提交了507例患者的数据，其中165例有不良预后。86例患者死亡，119例有不同程度的神经后遗症，79例（16%）患者出现神经后遗症。完整模型包括13个变量。年龄、恶心、呕吐、意识改变、脑积水、血管炎、免疫抑制、糖尿病和神经功能缺损保留在最终模型中。在严重程度量表中为变量分配1 - 3分，量表分数范围为1 - 6分。1 - 6分的死亡率分布分别为3.4%、8.2%、20.6%、31%、30%和40.1%。意识改变、糖尿病、免疫抑制、神经功能缺损、脑积水和血管炎在评分中预测不良预后，累积评分提供了预后的线性估计。
