Clinical Features And Prognostic Factors Of Tuberculous Menigitis:A Multivariate Of 154 Aduluts

Objective: To study the clinical features and predictive factors of tuberculous meningitis(TBM)for better diagnosis and treatment of TBM.Methods: A retrospective follow-up study was used to collect clinical features and outcomes of adult TBM at the First Affiliated Hospital of Chongqing Medical University from June 2012 to August 2015.Univariate analysis and multivariate analysis were used to identify predictive factors associated with outcomes at discharge and follow-up.Results:(1)TBM patients(N=154)were a median age of 41 years,and 87 were male.(2)52.6% cases were characterized by the clinical triad of headache,fever and neck stiffness,92.9% cases presented with at least two of the three symptoms.(3)TB other than CNS was found in patients at admission.Pulmonary was the most common religion involved(71cases,50.7%).(4)Systemic complications accounted for 15.2%(5/33)of all deaths in this study.The cause of death for older patients were more likely for systemic complication than neurological complications compared with the young.Pneumonia and gastrointestinal bleeding was the most common systemic complications,both of them indicate worse outcome.In addition,hemorrhage of digestive track could delay discharge leading to serious medical burden.(5)Limb weakness,cranial-nerve palsy,hydrocephalus,GCS scores were independent predictors for a poor outcome.(6)A high neutrophil to lymphocytes ratio,high D-dimer,a low albumin may be the biomarkers of the predictive factors.(7)Slow background activity and epileptiform discharges were the prominent electroencephalogram(EEG)abnormalities,slow background activity may be a predictor for the prognosis of TBM.(8)47(31%)patients had a poor outcome and the overall mortality was 21 %(33)at follow-up,including 10%(16)happened at discharge and the majority of death cases(94%)happened in the first year.Conclusions: Mortality and disability associated with TBM are high in China.Limb weakness,GCS scores,cranial-nerve palsy and hydrocephalus were independent predictors of poor outcomes,and AGR,NLR,D-dimer,and EEG abnormalities may be prognostic factors of disease.