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Prognostic Models for 9-Month Mortality in Tuberculous Meningitis.

Le Thi Phuong Thao1, A Dorothee Heemskerk1,2, Ronald B Geskus1,2

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Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
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New prognostic models predict 9-month mortality in tuberculous meningitis (TBM) patients, with or without HIV. These tools help identify high-risk individuals needing extra care.

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HIVmortalityprognostic modelstuberculous meningitis

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Area of Science:

  • Infectious Diseases
  • Neurology
  • Public Health

Background:

  • Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis.
  • Prognostic models for 9-month mortality in adults with TBM, considering HIV status, were developed and validated.

Purpose of the Study:

  • To develop and validate prognostic models for predicting 9-month mortality in adult TBM patients.
  • To identify key predictors of mortality in both HIV-uninfected and HIV-infected TBM populations.
  • To provide a clinical tool for risk stratification and improved patient management.

Main Methods:

  • Multivariable Cox proportional hazards regression was used for modeling.
  • Data from 1699 subjects across 4 clinical trials and 1 observational study in Vietnam (2001-2015) were analyzed.
  • Models were validated internally and temporally, and presented via nomograms and a web application.

Main Results:

  • Mortality rates were 23.0% in HIV-uninfected and 51.3% in HIV-infected TBM patients.
  • Common mortality predictors included higher MRC disease severity and lower CSF lymphocyte count.
  • Specific risk factors varied by HIV status, with models showing good discrimination (AUCs 0.77-0.78).

Conclusions:

  • Developed prognostic models demonstrate good performance for clinical use.
  • These models can assist physicians in identifying TBM patients at high risk of death.
  • The tools facilitate timely and targeted supportive care for critically ill TBM patients.