Prognostic Models for 9-Month Mortality in Tuberculous Meningitis

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.