Stadelman Anna M, Ellis Jayne, Samuels Thomas H A, Mutengesa Ernest, Dobbin Joanna, Ssebambulidde Kenneth, Rutakingirwa Morris K, Tugume Lillian, Boulware David R, Grint Daniel, Cresswell Fiona V
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.
Open Forum Infect Dis. 2020 Jun 30;7(8):ofaa257. doi: 10.1093/ofid/ofaa257. eCollection 2020 Aug.
There is substantial variation in the reported treatment outcomes for adult tuberculous meningitis (TBM). Data on survival and neurological disability by continent and HIV serostatus are scarce.
We performed a systematic review and meta-analysis to characterize treatment outcomes for adult TBM. Following a systematic literature search (MEDLINE and EMBASE), studies underwent duplicate screening by independent reviewers in 2 stages to assess eligibility for inclusion. Two independent reviewers extracted data from included studies. We employed a random effects model for all meta-analyses. We evaluated heterogeneity by the statistic.
We assessed 2197 records for eligibility; 39 primary research articles met our inclusion criteria, reporting on treatment outcomes for 5752 adults with TBM. The commonest reported outcome measure was 6-month mortality. Pooled 6-month mortality was 24% and showed significant heterogeneity ( > 95%; < .01). Mortality ranged from 2% to 67% in Asian studies and from 23% to 80% in Sub-Saharan African studies. Mortality was significantly worse in HIV-positive adults at 57% (95% CI, 48%-67%), compared with 16% (95% CI, 10%-24%) in HIV-negative adults ( < .01). Physical disability was reported in 32% (95% CI, 22%-43%) of adult TBM survivors. There was considerable heterogeneity between studies in all meta-analyses, with statistics consistently >50%.
Mortality in adult TBM is high and varies considerably by continent and HIV status. The highest mortality is among HIV-positive adults in Sub-Saharan Africa. Standardized reporting of treatment outcomes will be essential to improve future data quality and increase potential for data sharing, meta-analyses, and facilitating multicenter tuberculosis research to improve outcomes.
成人结核性脑膜炎（TBM）报告的治疗结果存在很大差异。关于各大洲以及HIV血清学状态的生存和神经功能障碍的数据稀缺。
我们进行了一项系统评价和荟萃分析，以描述成人TBM的治疗结果。在进行系统的文献检索（MEDLINE和EMBASE）之后，研究由独立评审员分两个阶段进行重复筛选，以评估纳入资格。两名独立评审员从纳入研究中提取数据。所有荟萃分析均采用随机效应模型。我们通过I²统计量评估异质性。
我们评估了2197条记录的资格；39篇主要研究文章符合我们的纳入标准，报告了5752例成人TBM的治疗结果。最常报告的结局指标是6个月死亡率。汇总的6个月死亡率为24%，并显示出显著的异质性（I²>95%；P<0.01）。在亚洲的研究中，死亡率在2%至67%之间，在撒哈拉以南非洲的研究中，死亡率在23%至80%之间。HIV阳性成人的死亡率明显更高，为57%（95%CI，48%-67%），而HIV阴性成人的死亡率为16%（95%CI，10%-24%）（P<0.01）。32%（95%CI，22%-43%）的成人TBM幸存者报告有身体残疾。在所有荟萃分析中，各研究之间存在相当大的异质性，I²统计量始终>50%。
成人TBM的死亡率很高，并且因大洲和HIV状态而有很大差异。撒哈拉以南非洲的HIV阳性成人死亡率最高。标准化报告治疗结果对于提高未来数据质量、增加数据共享、荟萃分析的可能性以及促进多中心结核病研究以改善结局至关重要。
