Department of Neurology, King George Medical University, Lucknow, India.
Department of Microbiology, King George Medical University, Lucknow, India.
Am J Trop Med Hyg. 2019 Aug;101(2):357-361. doi: 10.4269/ajtmh.19-0098.
Most deaths in tuberculous meningitis occur in the early part of the illness. We assessed the determinants of early deaths, occurring within 2 months of intensive therapy. We prospectively included consecutive newly diagnosed adults with HIV-negative tuberculous meningitis. Patients were given WHO-recommended antituberculosis treatment and were followed up for 9 months. We enrolled 152 patients. A total of 26 deaths were recorded during 2 months. The logistic regression analysis revealed that papilledema ( = 0.029, odds ratio (OR) = 4.8 [1.2-19.8]), increasing age ( = 0.001, OR = 1.07 [1.03-1.1]), stage-III disease (Glasgow coma scale score ≤ 10; = 0.01, OR = 4.2 [1.4-12.3]), and hydrocephalus ( = 0.003, OR = 8.4 [2.1-33.6]) were independently associated with death. In addition, cerebral infarcts ( = 0.012, OR = 5.6 [1.5-21.3]), paraparesis ( = 0.004, OR = 8.8 [2.02-38.1]), and age ( = 0.005, OR = 1.05 [1.02-1.09]) were associated with poor functional outcome. In conclusion, disease severity predicts early deaths in tuberculous meningitis.
大多数结核性脑膜炎患者的死亡发生在疾病的早期。我们评估了强化治疗后 2 个月内发生的早期死亡的决定因素。我们前瞻性地纳入了连续诊断为 HIV 阴性结核性脑膜炎的成人患者。患者接受了世界卫生组织推荐的抗结核治疗，并随访了 9 个月。我们共纳入 152 例患者。在 2 个月内共记录到 26 例死亡。逻辑回归分析显示，视乳头水肿（ = 0.029，比值比（OR）= 4.8 [1.2-19.8]）、年龄增加（ = 0.001，OR = 1.07 [1.03-1.1]）、III 期疾病（格拉斯哥昏迷量表评分≤ 10； = 0.01，OR = 4.2 [1.4-12.3]）和脑积水（ = 0.003，OR = 8.4 [2.1-33.6]）与死亡独立相关。此外，脑梗死（ = 0.012，OR = 5.6 [1.5-21.3]）、截瘫（ = 0.004，OR = 8.8 [2.02-38.1]）和年龄（ = 0.005，OR = 1.05 [1.02-1.09]）与不良功能结局相关。总之，疾病严重程度预测结核性脑膜炎的早期死亡。
