Evaluation Of The Applicability Of Tuberculous Meningitis Scoring Critira And Investigation Of Risk Factors For Poor Prognosis Of Tuberculous Meningitis

Objective(1)To evaluate the diagnostic efficacy and assess the clinical applicability of the clinical scoring critira for tuberculous meningitis.(2)To investigate the risk factors for poor prognosis of tuberculous meningitis.Methods We collected the data of patients who were dignosed with tuberculous meningitis,tuberculous meningoencephalitis or tuberculous cerebrospinal meningitis in the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2016 retrospectively.Excluded those repeated hospitalization,diagnosed with other type of central nervous system infectious diseases and whose medical records were incomplete or lost cases.Each patient was scored by tuberculous meningitis scoring critira and then divided into four groups.They were the definite group,the probable group,the possible group and the not tuberculous meningitis group.Patients were followed up by telephone through themselves or the other famly members who knowed about the condition.On the one hand,we collected the informations of misdiagnosis cases.Referring to the follow-up information,we could assess the diagnostic sensitivity of tuberculous meningitis scoring critira.Meanwhile,patients were also divided into two groups according to the improved rankin sacle.One was good prognosis(mRS < 3)and the other was poor prognosis(mRS?3).We analyzed the clinical data of the two groups and tried to explore the risk factors lead to poor prognostic of tuberculous meningitis.Results(1)The first part was to evaluate the efficacy of the tuberculous meningitis scoring system.According to the tuberculous meningitis scoring system,0 case was admitted to the definite group,56 cases(32.75%)were admitted to the probable group,109 cases(63.74%)were admitted to the possible group and 6 cases(3.51%)were admitted to the not tuberculous meningitis group.Meanwhile,157 cases(91.81%)were divided into definite group and the rest 14 cases(8.19%)were divided into not tuberculous meningitis group according to the follow-up results.Referring to the latter grouping method,the sensitivity of the tuberculous meningitis scoring system was 96.18%.(2)The second part was to investigate the risk factors for adverse outcome of tuberculous meningitis.The 157 definite cases were grouped again by mRS scales.Group one with a good prognosis contained 129 cases(82.17%)and group two with a poor prognosis contained 28 cases(17.83%).The univariate analysis revealed 12 factors with a poor prognosis: gender,postive pyramidal signs,disturbance of consciousness,hydrocephalus,cerebral infarction,tuberculoma,whether the application of intrathecal injection,whether the application of steroid hormenes and the way of medication,the onset of treament from the beginning of the disease,cerebrospinal fluid protein and chloride.Multivariate logistic analysis revealed three independent risk factors for a poor prognosis: the onset of treament from the beginning of the disease(P=0.001,OR=1.017,95%CI: 1.007~1.028),disturbance of consciousness(P=0.004,OR=4.324,95%CI: 1.578~11.851),and pathology positive(P=0.011,OR=3.968,95%CI: 1.368~11.505).Conclusions(1)The TBM scoring critira might have a good predictive value in early diagnosis of tuberculous meningitis,and it could be widely applied to clinical routine.(2)The onset of treament from the beginning of the disease,disturbance of consciousness and postive pyramidal signs were the risk factors caused poor prognosis of tuberculous meningitis.(3)Early diagnosis and trement played an important role in improving the prognosis of tuberculous meningitis.