Risk factors for poor outcome in childhood tuberculous meningitis

Mao-Shui Wang,Xin-Jie Liu,Mei Zhao

doi:10.1038/s41598-021-87082-5

Mao-Shui Wang, Xin-Jie Liu + Show 1 more

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https://doi.org/10.1038/s41598-021-87082-5

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Abstract

Tuberculous meningitis (TBM) remains a serious disease for children and its risk factors of poor outcome remain unclear. Therefore, a retrospective study was conducted aiming to investigate the risk factors associated with poor outcome of childhood TBM. Between January 2006 and December 2019, consecutive children patients (≤ 15 years old) who had a diagnosis of TBM were included for the analysis. The demographic, clinical, laboratory, and radiographic data were collected from the electronic medical records retrospectively. Poor outcome was defined as death or transfer to a higher-level hospital. Patients were then divided into good and poor outcome groups. Subsequently, risk factors for poor outcome were estimated using univariate and multivariate logistic regression analysis. A total of 149 children with TBM was enrolled, twenty-two patients suffered poor outcome, including 16 transfers to a higher-level hospital and 6 deaths, and the remaining 127 patients were classified as good outcome group. Further multivariate analysis revealed that coma (age- and sex-adjusted OR = 6.425, 95% CI: 1.743, 23.676; P < 0.01) and cerebrospinal fluid (CSF) protein (> 1188.3 mg/L; age- and sex-adjusted OR = 4.680, 95% CI: 1.469, 14.902; P < 0.01) were associated with the poor outcome of childhood TBM. Childhood TBM remains to have a high mortality rate in China. High CSF protein and coma were identified as risk factors for poor outcome of childhood TBM. Hence, more attention is required to be paid to suspected patients with such characteristics, thus facilitating access to optimum treatment.

Highlights

Tuberculous meningitis (TBM) remains a serious disease for children and its risk factors of poor outcome remain unclear
The current study aims to investigate the risk factors for a poor outcome of TBM in children
TBM was defined if one of the following criteria was met: (1) definite: acid fast bacilli (AFB, +) on cerebrospinal fluid (CSF) microscopy, or CSF TB-polymerase chain reaction (PCR)( +), or M.tuberculosis cultured from CSF. (2) conclusive: symptoms and signs of meningitis and CSF findings, plus at least one of the following (i) TB suggested by abnormal radiographic features, (ii) positive TB assays using non-CSF samples

Summary

Introduction

Tuberculous meningitis (TBM) remains a serious disease for children and its risk factors of poor outcome remain unclear. A retrospective study was conducted aiming to investigate the risk factors associated with poor outcome of childhood TBM. Childhood TBM remains to have a high mortality rate in China. A better management of childhood TBM is required to improve the current situation of TB patients, especially the survival rate. It is well-known that delays in initiating therapy for TBM would increase m ortality[7]. To characterize the risk factors associated with the poor outcome may improve the present situation in the management of childhood TBM. The current study aims to investigate the risk factors for a poor outcome of TBM in children. Our findings may be helpful in understanding the clinical characteristics of children patients with poor outcomes, and may improve the management of the disease

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