Comparison of the APACHE II, GCS and MRC scores in predicting outcomes in patients with tuberculous meningitis.
OBJECTIVE
To evaluate different scoring systems, including Acute Physiology and Chronic Health Evaluation (APACHE) II, the Glasgow Coma Scale (GCS) and the Medical Research Council (MRC) staging system, as well as other prognostic factors, in predicting the discharge outcomes of adult patients with tuberculous meningitis (TBM).


METHODS
We conducted a retrospective analysis of patients admitted with a diagnosis of TBM to a tertiary hospital in northern Taiwan from March 1996 to February 2006. We used APACHE II, GCS, MRC and a variety of factors within 24 h of admission to predict discharge outcomes recorded by the Glasgow Outcome Scale (GOS).


RESULTS
Among 43 TBM patients, 33 had a favourable outcome (GOS 4-5), and 10 had an unfavourable outcome (GOS 1-3). The severity of APACHE II, GCS, MRC and presence of hydrocephalus correlated well with the neurological outcomes (P < 0.05). The APACHE II and GCS scoring systems were more sensitive and specific than those of the MRC in receiver operating characteristic analysis. Furthermore, in-hospital mortality could be predicted accurately with APACHE II and GCS.


CONCLUSIONS
The APACHE II scoring system is at least as effective as GCS and superior to MRC in predicting the discharge outcomes of adult patients with TBM.
Chou
C-H
CH
Department of Neurology, Tri-Service General Hospital, Penghu Branch, Penghu, Taiwan.
Lin
G-M
GM
Ku
C-H
CH
Chang
F-Y
FY
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D055815:Young Adult