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dc.contributor.authorThao, Le Thi Phuong
dc.contributor.authorHeemskerk, A Dorothee
dc.contributor.authorGeskus, Ronald B
dc.contributor.authorMai, Nguyen Thi Hoang
dc.contributor.authorHa, Dang Thi Minh
dc.contributor.authorChau, Tran Thi Hong
dc.contributor.authorPhu, Nguyen Hoan
dc.contributor.authorChau, Nguyen Van Vinh
dc.contributor.authorCaws, Maxine
dc.contributor.authorLan, Nguyen Huu
dc.contributor.authorThu, Do Dang Anh
dc.contributor.authorThuong, Nguyen Thuy Thuong
dc.contributor.authorDay, Jeremy
dc.contributor.authorFarrar, Jeremy J
dc.contributor.authorTorok, M Estee
dc.contributor.authorBang, Nguyen Duc
dc.contributor.authorThwaites, Guy E
dc.contributor.authorWolbers, Marcel
dc.date.accessioned2018-05-02T08:50:48Z
dc.date.available2018-05-02T08:50:48Z
dc.date.issued2018-02-01
dc.identifier.issn1058-4838
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/275406
dc.description.abstractBackground: 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.
dc.description.sponsorshipThis 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.
dc.languageeng
dc.publisherOxford University Press
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectHIV
dc.subjectTuberculous meningitis
dc.subjectmortality
dc.subjectprognostic models
dc.titlePrognostic models for 9 month mortality in tuberculous meningitis
dc.typeArticle
prism.endingPage532
prism.issueIdentifier4
prism.publicationDate2018
prism.publicationNameClinical Infectious Diseases
prism.startingPage523
prism.volume66
dc.identifier.doi10.17863/CAM.22612
dcterms.dateAccepted2017-09-21
rioxxterms.versionofrecord10.1093/cid/cix849
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-02-01
dc.contributor.orcidTorok, Estee [0000-0001-9098-8590]
dc.identifier.eissn1537-6591
rioxxterms.typeJournal Article/Review
pubs.funder-project-idAcademy of Medical Sciences (unknown)
cam.issuedOnline2017-09-26


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International