title: Predictors of outcome in patients with tuberculous meningitis.
abstract: OBJECTIVE
  To assess predictors of mortality and neurological sequelae in patients with tuberculous meningitis (TBM).
  
  
  METHODS
  Patients with TBM treated at 12 university hospitals in Turkey between 1985 and 1997 were evaluated using a standardised protocol applied retrospectively. Variables associated with hospital mortality as well as with the presence of neurological sequelae at 6 months were determined using logistic regression models.
  
  
  RESULTS
  Four hundred and thirty-four patients between the ages of 13 and 83 years (mean 33 years) were evaluated. Sixty-eight per cent of these patients presented with Medical Research Council Stage II or III. One hundred and one patients (23.3%) died and 67 (27%) of evaluable survivors had neurological sequelae. In multi-variable analysis, convulsion (OR 3.3, 95%CI 1.2-9.0, P = 0.02), comatose mental status (OR 6.0, 95%CI 3.6-10.2, P = 0.01), and delayed or interrupted treatment (OR 5.1, 95%CI 2.4-11.2, P = 0.01) were shown to be predictors for mortality. The presence of extra-meningeal tuberculosis (OR 2.1, 95%CI 1.1-4.2, P = 0.035), cranial nerve palsy (OR 2.6, 95%CI 1.4-4.2, P = 0.01), hemiparesia/focal weakness (OR 9.3, 95%CI 3.8-22.6, P = 0.01), hemiplegia/multiple neurological deficit (OR 7.1, 95%CI 2.14-23.38, P = 0.01) and drowsiness (OR 4.2, 95%CI 2.04-8.82, P = 0.01) were independent predictors of neurological sequelae at 6 months following hospital discharge.
  
  
  CONCLUSIONS
  The results of this study emphasise the importance of prompt and uninterrupted anti-tuberculosis therapy for tuberculous meningitis. The presence of seizures or coma on admission to hospital are important predictors for mortality, while the presence of focal neurological signs is a predictor for persistent neurological sequelae in survivors.
authors.affiliation: Department of Clinical Microbiology, Dicle University Hospital, Diyarbakir, Turkey. hosoglu@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Hosoglu
authors.forename: M F
authors.initials: MF
authors.lastname: Geyik
authors.forename: I
authors.initials: I
authors.lastname: Balik
authors.forename: B
authors.initials: B
authors.lastname: Aygen
authors.forename: S
authors.initials: S
authors.lastname: Erol
authors.forename: T G
authors.initials: TG
authors.lastname: Aygencel
authors.forename: A
authors.initials: A
authors.lastname: Mert
authors.forename: N
authors.initials: N
authors.lastname: Saltoglu
authors.forename: I
authors.initials: I
authors.lastname: Dokmetas
authors.forename: S
authors.initials: S
authors.lastname: Felek
authors.forename: M
authors.initials: M
authors.lastname: Sunbul
authors.forename: H
authors.initials: H
authors.lastname: Irmak
authors.forename: K
authors.initials: K
authors.lastname: Aydin
authors.forename: O F
authors.initials: OF
authors.lastname: Kokoglu
authors.forename: H
authors.initials: H
authors.lastname: Ucmak
authors.forename: M
authors.initials: M
authors.lastname: Altindis
authors.forename: M
authors.initials: M
authors.lastname: Loeb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014390:Tuberculosis, Meningeal / Q000401:mortality*; D014421:Turkey / Q000453:epidemiology