title: Prognostic factors of tuberculous meningitis: a single-center study.
abstract: OBJECTIVE
  To investigate the prognostic factors of tuberculous meningitis (TBM) and develop strategies for the improvement of clinical efficacy.
  
  
  METHODS
  A total of 156 TBM patients were retrospectively reviewed. The demographic characteristics, underlying diseases, clinical features, laboratory findings, bacteriologic test, images, use of steroids, mannitol and anti-TB drugs, surgery or drainage, and clinical outcomes were collected and analyzed.
  
  
  RESULTS
  Patients with tubercle bacillus in the cerebrospinal fluid had significantly higher rate of consciousness disturbance (78.8%) and greater proportion of Glasgow coma scale (GCS) score of 3 (37.9%) when compared with the possible TBM patients (51.1% and 13.3%, respectively). Patients with definite TBM had a poor outcome and their mortality was significantly higher than in possible TBM patients (42.4% vs. 17.8%, P < 0.05). Univariate regression analysis showed that the advanced age, concomitant hematogenous disseminated pulmonary tuberculosis, change in consciousness, low GCS score on admission and hydrocephalus were associated with a poor prognosis; timely anti-TB treatment and reasonable hormone applications predicted a favorable outcome. Multivariate regression analysis showed that advanced age, change in consciousness, low GSC score and concomitant hydrocephalus were independent risk factors of TBM, and use of prednisone at ≥ 60 mg/d was protective factor for TBM (P=0.003, OR=0.013).
  
  
  CONCLUSIONS
  The advanced age, changes in consciousness, low GCS score on admission and concomitant hydrocephalus are independent risk factors of TBM. For patients with risk factors, diagnostic anti-TB therapy and reasonable hormone therapy should be performed timely to reduce mortality and disability.
authors.affiliation: Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine Shanghai 200433, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Gu
authors.affiliation: Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine Shanghai 200433, China.
authors.forename: Heping
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine Shanghai 200433, China.
authors.forename: Furong
authors.initials: F
authors.lastname: Wu
authors.affiliation: Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine Shanghai 200433, China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Ge
authors.affiliation: Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine Shanghai 200433, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine Shanghai 200433, China.
authors.forename: Wenwen
authors.initials: W
authors.lastname: Sun
keywords: Tuberculous meningitis; prognosis; prognostic factors