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Prognostic models for 9 month mortality in tuberculous meningitis

Published version
Peer-reviewed

Type

Article

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Authors

Thao, Le Thi Phuong 
Heemskerk, A Dorothee 
Geskus, Ronald B 
Mai, Nguyen Thi Hoang 
Ha, Dang Thi Minh 

Abstract

Background: Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis. We developed and validated prognostic models for 9-month mortality in HIV-uninfected and HIV-infected adults with TBM. Methods: We included 1699 subjects from four randomized clinical trials and one prospective observational study conducted at two major referral hospitals in Southern Vietnam from 2001-2015. Modelling was based on multivariable Cox proportional hazards regression. The final prognostic models were validated internally and temporally, and displayed using nomograms and a web-based app (https://thaole.shinyapps.io/tbmapp/). Results: A total of 951 HIV-uninfected and 748 HIV-infected subjects with TBM were included, of whom 219/951 (23.0%) and 384/748 (51.3%) died during 9-month follow-up. Common predictors for increased mortality in both populations were higher Medical Research Council (MRC) disease severity grade and lower cerebrospinal fluid lymphocyte cells count. In HIV-uninfected subjects, older age, previous tuberculosis, not receiving adjunctive dexamethasone, and focal neurological signs were additional risk factors; in HIV-infected subjects, lower weight, lower peripheral blood CD4 cell count, and abnormal plasma sodium were additional risk factors. The areas under the receiver operating characteristic curves (AUCs) for the final prognostic models were 0.77 (HIV-uninfected population) and 0.78 (HIV-infected population), demonstrating markedly better discrimination than the MRC grade (AUC 0.66 and 0.70) or the Glasgow Coma Score (AUC 0.68 and 0.71) alone. Conclusions: The developed models showed good performance and could be used in clinical practice to assist doctors in identifying TBM patients at high risk of death and at increased need of supportive care.

Description

Keywords

HIV, Tuberculous meningitis, mortality, prognostic models

Journal Title

Clinical Infectious Diseases

Conference Name

Journal ISSN

1058-4838
1537-6591

Volume Title

66

Publisher

Oxford University Press
Sponsorship
Academy of Medical Sciences (unknown)
This work was supported by the Academy of Medical Sciences and the Health Foundation (Clinician Scientist Fellowship to M. E. T.), the National Institute of Health Research Cambridge Biomedical Research Centre (M. E. T), and a Wellcome Trust Intermediate Fellowship (grant number WT097147MA) to J.D.