Risk factors for poor outcome in childhood tuberculous meningitis

Abstract

Tuberculous meningitis (TBM) remains a serious disease for children and its risk factors of poor outcome remain unclear. Therefore, a retrospective study was conducted aiming to investigate the risk factors associated with poor outcome of childhood TBM. Between January 2006 and December 2019, consecutive children patients (≤ 15 years old) who had a diagnosis of TBM were included for the analysis. The demographic, clinical, laboratory, and radiographic data were collected from the electronic medical records retrospectively. Poor outcome was defined as death or transfer to a higher-level hospital. Patients were then divided into good and poor outcome groups. Subsequently, risk factors for poor outcome were estimated using univariate and multivariate logistic regression analysis. A total of 149 children with TBM was enrolled, twenty-two patients suffered poor outcome, including 16 transfers to a higher-level hospital and 6 deaths, and the remaining 127 patients were classified as good outcome group. Further multivariate analysis revealed that coma (age- and sex-adjusted OR = 6.425, 95% CI: 1.743, 23.676; P < 0.01) and cerebrospinal fluid (CSF) protein (> 1188.3 mg/L; age- and sex-adjusted OR = 4.680, 95% CI: 1.469, 14.902; P < 0.01) were associated with the poor outcome of childhood TBM. Childhood TBM remains to have a high mortality rate in China. High CSF protein and coma were identified as risk factors for poor outcome of childhood TBM. Hence, more attention is required to be paid to suspected patients with such characteristics, thus facilitating access to optimum treatment.

The Sensitivity of Diagnostic Criteria of Marais S, et al. in Confirmed Childhood Tuberculous Meningitis

“…Moreover, limited techniques for effective TBM diagnosis in children, such as Xpert Ultra, are currently available (7). Two key factors are responsible for the diagnostic limitations in childhood TBM: (1) cerebrospinal fluid (CSF) is a paucibacillary specimen type and (2) TB in children is often paucibacillary. In addition, TBM is difficult to treat and often responds poorly to conventional TB treatment (8,9).…”

“…The Marais classification criteria are based on Thwaites' Index, which has previously shown good performance (12)(13)(14). However, these criteria are associated with a number of disadvantages that need to be addressed: (1) the difference between childhood and adult TBM is not fully considered, (2) the scoring system is presented as a personal view and lacks sufficient data to support its efficiency, and (3) insufficient information is available on the utility of the criteria in China.…”

“…Tuberculous meningitis (TBM) is an ongoing serious threat to child health. In China, 9.4% of children with tuberculosis (TB) are diagnosed with TBM, with 14.7% showing poor outcomes, such as death and transferred to a high care center ( 1 , 2 ). Diagnostic delay is an important contributor to mortality in childhood-associated TBM ( 3 ).…”

Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability

“…Lack of access to supportive care and neurorehabilitation in low-resourced, TB-endemic settings further exacerbate poor outcomes [97]. Whilst reasons for poor outcomes are likely to be multifactorial, diagnosis before the onset of coma remains the most crucial factor predicting survival and favourable outcomes [98].…”

Tuberculous Meningitis in Children: Treatment Outcomes at Discharge and Its Associated Factors in Eastern Ethiopia: A Five Years Retrospective Study

“…11–13 Moreover, advanced stage of TBM, 4 , 5 , 12–15 coma at presentation, delay in diagnosis and treatment, and complications such as hydrocephalus are significantly associated factors. 16–19 Few studies in central Ethiopia have revealed that TBM in children leads to poor treatment outcomes. For example, TBM-related death ranges from 14% to 43%, and neurological deficits range from 28% to 47%.…”