Clinical features and influencing factors of long-term prognosis in patients with tuberculous meningitis
10.3760/cma.j.cn112138-20220121-00069
- VernacularTitle:结核性脑膜炎患者临床特征和远期预后影响因素分析
- Author:
Zhengrong YANG
1
;
Lifan ZHANG
;
Baotong ZHOU
;
Xiaochun SHI
;
Wei CAO
;
Hongwei FAN
;
Zhengyin LIU
;
Taisheng LI
;
Xiaoqing LIU
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院感染内科 疑难重症及罕见病国家重点实验室，北京100730
- Keywords:
Meningitis;
Tuberculosis, Meningeal;
Risk factors;
Clinical features;
Prognosis
- From:
Chinese Journal of Internal Medicine
2022;61(7):764-770
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical features and influencing factors of long-term prognosis of tuberculous meningitis(TBM), and to provide a recommendation for treatment and early intervention of TBM.Methods:Clinical data of TBM patients were retrospectively collected at Peking Union Medical College Hospital from January 2014 to December 2021. Patients who were followed-up more than one year were divided into two groups according to modified Rankin Scale (mRS). Risk factors associated with long-term prognosis were analyze by conditional logistic stepwise regression.Results:A total of 60 subjects were enrolled including 33 (55%) males and 27 (45%) females with age 15-79 (44.5±19.8) years. There were 30 cases (50%) complicated with encephalitis, 21 cases (35%) with miliary tuberculosis. The diagnosis was microbiologically confirmed in 22 patients (36.7%), including 5 cases (22.7%, 5/22) by acid-fast staining, 8 cases (36.4%, 8/22) by Mycobacterium tuberculosis (MTB) culture, and 20 cases (90.9%, 20/22) by molecular biology. The median follow-up period was 52(43, 66 ) months in 55 cases surviving more than one year. Among them, 40 cases (72.7%) were in favorable group (mRS 0-2) and 15 cases (27.3%) were in unfavorable group (mRS 3-6) with poor prognosis. The mortality rate was 20% (11/55). Elderly ( OR=1.06, P=0.048 ) , hyponatremia( OR=0.81, P=0.020), high protein level in cerebrospinal fluid (CSF) ( OR=3.32, P=0.033), cerebral infarction( OR=10.50, P=0.040) and hydrocephalus( OR=8.51, P=0.049) were associated with poor prognosis in TBM patients. Conclusions:The mortality rate is high in patients with TBM. Molecular biology tests improves the sensitivity and shorten the diagnosis time of TBM. Elderly, hyponatremia, high protein level in CSF, cerebral infarction and hydrocephalus are independent risk factors of long-term survival in TBM patients.
