BMRC-MV Is the Best Staging Scale for Predicting Outcome of Tuberculous Meningitis

Abstract

Background: Tuberculous meningitis (TBM) patients in any stage of British Medical Research Council (BMRC) scale if need mechanical ventilation (MV) are likely to have poor outcome; therefore they may be grouped as stage IV for better prediction. We report usefulness of BMRC, BMRC-MV and BMRC-HC (hydrocephalus) staging, and HAMSI scoring in predicting outcome of TBM. Methods: 197 TBM patients were retrospectively analyzed from a TBM registry of a tertiary care teaching institute in India. The severity of meningitis was categorized using BMRC (stage I-III), BMRC-MV [I-IV (MV patients grouped as stage IV) and BMRC-HC (BMRC stage III with hydrocephalus grouped as stage IV). HAMSI scoring was done and categorized as 6. All the patients received standard antitubercular treatment. Outcome was defined at 6 months using modified Rankin Scale (mRS) as death, poor (mRS score >2) or good (mRS < 2). Findings: 49 (25%) patients died. BMRC-MV stage IV had the highest predictive value for defining death with a sensitivity of 88% and specificity of 86%; whereas BMRC stage III had a sensitivity of 41% and specificity of 70%. 128 (76.6%) of surviving patients has good outcome. BMRC-MV stage I-III had the highest predictive value for defining good outcome with a sensitivity of 93% and specificity of 61%; whereas it was 75% and 41% respectively for BMRC stage I and II. BMRC-HC staging and HAMSI scoring had a poor predictive value. Interpretation: In TBM, BMRC-MV staging has the best predictive value for defining death and disability. Funding Statement: This study was partly supported by Indian council of Medical Research, Government of India. Declaration of Interests: The authors state: None. Ethics Approval Statement: The patients with TBM admitted during 2014-2018 were included from a prospectively maintained TBM registry, which were approved by the Institute Ethics Committee (2013-83-EMP-72; 2018/165PGI-BE).