Risk Factors And Outcome Of Gastrointestinal Bleeding In Tuberculous Meningitis In A Neurology Intensive Care Unit

Objective:To investigate the clinical features and risk factors of gastrointestinal bleeding(GIB)in adult patients with tuberculous meningitis(TBM)and its prognostic significance in a neurology intensive care unit(NICU).Methods:We conducted a retrospective study.Consecutive adult patients with TBM,who were admitted to NICU at the First Affiliated Hospital of Chongqing Medical University from January 2012 to December 2017,were included finally.Clinical variables,any episode of bleeding,and outcome were recorded according to application of electronic medical record system.Univariate and multivariate analyses were used to identify the risk factors of GIB.And the effect of GIB on prognosis was also discussed.Results:(1)In this study,a total of 108 patients with TBM in NICU were enrolled,there were 59 males and 49 females(M/F ratio:1.2),with a mean age of 43 years.(2)GIB was observed in 28 patients during hospitalization.23 patients(82.1%)occurred in first week and 5 patients developed GIB between one week and two weeks.Among 28 patients with GIB,4 cases presented as vomiting fresh blood,14 cases had coffee ground material in nasogastric aspirate,and other 10 cases presented as melena.(3)GIB in TBM was not severe in most patients which could be cured by temporary fasting and proton pump inhibitor,and blood transfusion and surgical intervention were not performed.The bleeding time did not exceed one week,and for most patients(82.1%)were three days.(4)The significant parameters related to GIB included GCS score on admission,altered consciousness,moderately severe intracranial hypertension(intracranial pressure>250mmH20)and TBM stage ?;After adjusting for potential confounding factors,TBM stage ? and moderately severe intracranial hypertension were independent risk factors of GIB on multivariate analysis.(5)When compared with TBM patients without GIB in NICU,GIB group was associated with higher rate of nosocomial pneumonia,respiratory failure,mechanical ventilation during hospitalization,and these patients often had poor outcome and high death rate.Conclusion:GIB was common in adult patients with TBM during hospitalization in NICU,which was associated with death and severe dependence.TBM stage ? and moderately severe intracranial hypertension may be its risk factors.