Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China

Background Tuberculous meningitis (TBM) is the most lethal form of tuberculosis worldwide. Data on critically ill TBM patients in the intensive care unit (ICU) of China are lacking. We tried to identify prognostic factors of adult TBM patients admitted to ICU in China. Methods We conducted a retrosp...

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Bibliographic Details
Published in:BMC neurology 2021-08, Vol.21 (1), p.1-308, Article 308
Main Authors: Feng, Baobao, Fei, Xiao, Sun, Ying, Zhang, Xingguo, Shang, Deya, Zhou, Yi, Sheng, Meiyan, Xu, Jiarui, Zhang, Wei, Ren, Wanhua
Format: Article
Language:English
Subjects:
Care and treatment
Critically ill
HIV
Hospitals
Human immunodeficiency virus
Intensive care
Intensive care unit
Intensive care units
Mechanical ventilation
Medical prognosis
Medical research
Meningitis
Mortality
Patients
Prognosis
Prognostic factors
Regression analysis
Statistics
Steroids
Tuberculosis
Tuberculous meningitis
Ventilators
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Summary:Background Tuberculous meningitis (TBM) is the most lethal form of tuberculosis worldwide. Data on critically ill TBM patients in the intensive care unit (ICU) of China are lacking. We tried to identify prognostic factors of adult TBM patients admitted to ICU in China. Methods We conducted a retrospective study on adult TBM in ICU between January 2008 and April 2018. Factors associated with unfavorable outcomes at 28 days were identified by logistic regression. Factors associated with 1-year mortality were studied by Cox proportional hazards modeling. Results Eighty adult patients diagnosed with TBM (age 38.5 (18-79) years, 45 (56 %) males) were included in the study. An unfavorable outcome was observed in 39 (49 %) patients and were independently associated with Acute Physiology and Chronic Health Evaluation (APACHE) II > 23 (adjusted odds ratio (aOR) 5.57, 95 % confidence interval (CI) 1.55-19.97), Sequential Organ Failure Assessment (SOFA) > 8 (aOR 9.74, 95 % CI 1.46-64.88), and mechanical ventilation (aOR 18.33, 95 % CI 3.15-106.80). Multivariate Cox regression analysis identified two factors associated with 1-year mortality: APACHE II > 23 (adjusted hazard ratio (aHR) 4.83; 95 % CI 2.21-10.55), and mechanical ventilation (aHR 9.71; 95 % CI 2.31-40.87). Conclusions For the most severe adult TBM patients of Medical Research Council (MRC) stage III, common clinical factors aren't effective enough to predict outcomes. Our study demonstrates that the widely used APACHE II and SOFA scores on admission can be used to predict short-term outcomes, while APACHE II could also be used to predict long-term outcomes of adult patients with TBM in ICU. Keywords: Tuberculous meningitis, Prognostic factors, Intensive care unit
ISSN:1471-2377
1471-2377
DOI:10.1186/s12883-021-02340-3