Abstract:

Objective To analyze the clinical characteristics and prognostic factors of human immunodeficiency virus (HIV)-negative tuberculous meningitis (TBM) patients.Methods The clinical data of 77 patients with HIV-negative TBM clinically diagnosed in the Department of Tuberculosis of The Fifth People’s Hospital of Suzhou from January 2012 to December 2017 were retrospectively analyzed. According to the modified Rankin scale (mRS) score at discharge, patients were divided into the group with good prognosis (mRS score: 0-2) and the group with poor prognosis (mRS score: 3-6). The clinical characteristics of patients in the good prognosis group and the poor prognosis group were compared, and the risk factors affecting the prognosis of patients were analyzed by conditional logistic stepwise regression.Results Among the 77 patients, the common clinical symptoms were headache (68 cases, 88.3%), fever (75 cases, 97.4%) and night sweats (69 cases, 89.6%). Cerebrospinal fluid glucose levels (median (quartile): 1.8 (1.4, 2.3) mmol/L), chloride ((109.37±13.68) mmol/L) increased, and protein level (median (quartile): 1994.5 (1257.5, 2888.3) g/L) decreased. Among the 77 patients, 41 had a good prognosis and 36 had a bad prognosis. The incidence of paralysis in the good prognosis group was 7.3% (3/41), significantly lower than that in the poor prognosis group (41.7%, 15/36), and the difference was statistically significant (χ ²=12.63, P=0.000). According to Glasgow coma score (GCS), patients with mild coma (13-14 points), moderate coma (9-12 points) and severe coma (3-8 points) in the group with good prognosis accounted for 34.1% (14/41), 61.0% (25/41) and 4.9% (2/41), respectively. The patients with mild coma, moderate coma and severe coma in the group with poor prognosis accounted for 0.0% (0/36), 55.6% (20/36) and 44.4% (16/36), respectively. The differences between the two groups were statistically significant (χ ²=4.99, P=0.000). Logistic regression analysis showed that HIV-negative TBM patients with paralysis (OR (95%CI): 10.75 (1.53-76.92)) and severe coma (OR (95%CI): 10.42 (2.11-52.63)) had poor prognosis. Conclusion Fever, night sweats and headache are the most common clinical symptoms of HIV-negative TBM. Paralysis and poor GCS score are independent risk factors for poor prognosis in HIV-negative TBM patients.

Key words: Tuberculosis, meningeal, Signs and symptoms, Prognosis, Risk factors, Factor analysis, statistical