Tuberculous meningitis: do modern diagnostic tools offer better prognosis prediction.
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Date
2013-01
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Abstract
Background: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease
severity and establish the approximate prognosis of tuberculous meningitis.
Aims: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical
features, laboratory tests and imaging.
Methods: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the
prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using
a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve.
Results: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101
(32.5%) survived with sequelae. The associated predictors were consciousness impairment (p= 0.010), motor deficit
(p = 0.003), cisternal effacement (p=0.006) and infarcts (p=0.015). The new score based on these predictors yielded a
larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI:
0.65-0.77).
Conclusions: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability
of modern tests did not improve the ability to predict a bad outcome.
Description
Keywords
Tuberculosis, Meningitis, Prognosis, Predictors
Citation
Alarcón Fernando, Moreira Juan, Rivera José, Salinas Robert, Dueñas Gonzalo, Ende Jef Van den. Tuberculous meningitis: do modern diagnostic tools offer better prognosis prediction. Indian Journal of Tuberculosis. 2013 Jan; 60(1): 5-14.