关键词: 结核, 脑膜, 残疾鉴定, 死亡率, 因素分析, 统计学

Abstract:

Objective: To explore the influencing factors of disability and mortality in HIV-negative patients with tuberculous meningitis (TBM), and to provide a basis for early identification and intervention in high-risk populations. Methods: We collected clinical data from patients diagnosed with and treated for TBM at Beijing Chest Hospital, Capital Medical University, from January 1, 2011, to December 31, 2023, and constructed a retrospective cohort. A total of 837 patients were included based on the inclusion and exclusion criteria. Data on patients’ age, sex, Glasgow Coma Scale (GCS) score, cerebrospinal fluid (CSF) etiological test result, diabetes comorbidity, multidrug-or rifampicin-resistance status, intrathecal drug administration via lumbar puncture, and steroid use were collected. Cox proportional-hazards regression was employed to identify factors influencing disability and mortality in HIV-negative TBM patients. Results: Among the 837 patients, 499 (59.62%) experienced disability, and 150 (17.92%) died. The Cox model revealed that age was an independent risk factor whereas high GCS was a protective factor for both disability and mortality (P<0.05). For disability, compared with patients aged ≤14 years, the adjusted hazard ratios (aHR) were 1.227 (95%CI: 1.030-1.460) for those aged 30-44 years, 1.284 (95%CI: 1.068-1.545) for those aged 45-59 years, and 1.350 (95%CI: 1.110-1.640) for those aged ≥60 years, indicating that the risk of disability increased with age. For GCS score, compared with patients with scores of 3-8, those with scores of 9-12 had an aHR of 0.741 (95%CI: 0.600-0.910), and those with scores of 13-15 had an aHR of 0.607 (95%CI: 0.480-0.760), indicating that the risk of disability decreased with increasing GCS score. Similarly, the Cox model showed that the risk of mortality also increased with age and decreased with increasing GCS score. Compared with patients aged ≤14 years, the aHRs for mortality were 1.246 (95%CI: 1.038-1.494) for those aged 30-44 years, 1.323 (95%CI: 1.100-1.594) for those aged 45-59 years, and 1.419 (95%CI: 1.150-1.748) for those aged ≥60 years. For GCS score, compared with patients with scores of 3-8, those with scores of 9-12 had an aHR of 0.670 (95%CI: 0.540-0.830), and those with scores of 13-15 had an aHR of 0.549 (95%CI: 0.430-0.690). Conclusion: HIV-negative TBM patients aged over 30 years and with low GCS scores have a significantly increased risk of disability, which are also core determinants of mortality. Clinicians should focus on patients with advanced age and significant consciousness impairment (low GCS scores), implement individualized management, enhance monitoring, and optimize treatment plans to improve outcomes.

Key words: Tuberculosis, meningeal, Disability evaluation, Mortality, Factor analysis, statistical