Abstract:

Objective To analyze influencing factors for prognosis of tuberculous meningitis (TBM) with disturbance of consciousness.Methods Clinical data of 112 patients with consciousness disorder and TBM in Changsha Central Hospital from January 2013 to January 2019 was retrospectively analyzed. 21 (18.8%) patients were definite TBM cases while 84 (75.0%) were probable TBM cases, and 7 (6.2%) were possible TBM cases. According to their scores of modified Rankin scale (mRS) assessed at discharge from hospital, patients were divided into 48 (42.9%) patients with good prognosis and 64 (57.1%) patients with poor prognosis. There were 24 males with good prognosis. The median age was 18.50 (5.31, 3.75) years and the median duration of disease was 20.00 (11.25, 30.00) days. There were 20 males in the poor prognosis group, with a median age of 27.00 (3.06, 49.75) years and a duration of 15.00 (10.00, 20.00) days. Logistic regression analysis was used to analyze influencing factors of poor prognosis of patients.Results Univariate analysis showed that hospital stay (Z=-1.982, P=0.048), sex (χ ²=4.043, P=0.044), disease stage (χ ²=17.733, P=0.000), convulsion (χ ²=8.054, P=0.005), hyponatremia (χ ²=9.481, P=0.002), brain edema (χ ²=4.386, P=0.036), hydrocephalus (χ ²=5.992, P=0.014) were influencing factors for poor prognosis among TBM patients with impaired consciousness. Multivariate analysis showed that hyponatremia (P=0.043, OR=2.784, 95%CI:1.034-7.495), stage Ⅲ of consciousness disturbance (P=0.002, OR=6.855, 95%CI:2.001-23.480), encephaledema (P=0.030, OR=3.491, 95%CI:1.132-10.768) were risk factors for poor prognosis. Conclusion Hyponatremia, stage Ⅲ of disease and brain edema are the main influencing factors for poor prognosis for TBM patients with disturbance of consciousness.

Key words: Tuberculosis, meningeal, Consciousness disorders, Prognosis, Risk factors, Factor analysis, statistical