Factors associated with poor outcome in tuberculous meningitis; study from a tertiary care referral Centre from South India

Abstract

Introduction: Tuberculosis (TB) remains a worldwide burden with a large majority of new activecases occurring in underdeveloped and developing countries. This study is an attempt to look intovarious aspects of the disease that can be associated with the outcome, to promote a timely referralto an appropriate centre. Purpose: To identify various clinical, lab, CSF and radiological variablesassociated with poor outcome of TBM at the time of discharge. Material & Methods: Demographicdata, duration of symptoms before diagnosis, clinical presentation, staging of the disease at the timeof admission of all the TBM patients who presented to our centre between December, 2015 and May2018 were noted. Results of biochemical investigations and brain and spine imaging were retrieved.Outcome at the time of discharge as measured by MRC and mRS grades was correlated to clinicalprofile, lab, CSF and radiological findings. Results: A total of 100 patients were included. 15patients died. Subjects with MRC and mRS grades of 2 or more at admission constituted 65% and93% respectively. At discharge, MRC and mRS grades of 2 or more were found in 29.63% and 39%respectively. Multivariable analysis showed a significant positive association of MRC stage atdischarge with MRC stage (p = 0.001) and mRS score (p = 0.001) at admission and Vellorehydrocephalus grade (p < 0.001) when hydrocephalus first identified. Conclusion: Stage of thedisease (MRC) and functional status of the patient (mRS) at admission are the two most importantindependent factors determining the outcome of TBM patients at the time of discharge.