The Clinical and Epidemiologic Factors Associated with Mortality in Tuberculous Meningitis in Ceará State, Brazil

The aim of this study was to characterize and evaluate the risk factors for mortality in hospitalized patients with tuberculous meningitis (TBM). This was a retrospective study of hospitalized patients with TBM between 2016 and 2023 in Ceará State, Brazil. Generalized linear regression was performed to identify factors predictive of in-hospital mortality. The British Medical Research Council Severity (BMRCS) grading system for TBM was evaluated upon patient admission. Of the 94 patients with TBM enrolled in the study, the median age was 39.6 years, 86.7% were men, 81.2% were positive for HIV upon admission, 33.0% had prior tuberculosis, and 4.3% had multidrug-resistant infections. In-hospital mortality was 31.9% for all patients with a final diagnosis of TBM. When multivariable analysis was applied, significant associations with increased in-hospital mortality were seen among patients with BMRCS grade III (odds ratio [OR] 1.42; 95% CI 0.49-4.08), low hemoglobin levels (OR 6.44; 95% CI 0.59-70.27), low hematocrit levels (OR 0.53; 95% CI 0.04-5.97), higher aspartate aminotransferase (AST) levels (OR 1.98; 95% CI 0.67-5.77), and fewer cerebrospinal fluid (CSF) lymphocytes (OR 1.38; 95% CI 0.50-3.80) and decreased in-hospital mortality in those with orally administered rifampin, isoniazid, pyrazinamide, and ethambutol (RHZE) (OR 0.28; 95% CI 0.10-0.79). Mortality was higher among patients with BMRCS grade III, low hemoglobin levels, low hematocrit levels, higher AST, and fewer CSF lymphocytes, and lower in those orally administered RHZE.