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Prognostic Value of C-Reactive Protein in Adults With Tuberculous Meningitis: A Prospective Cohort Study

Lillian Tugume1, Fiona V Cresswell1,2,3, Nicole W Engen4

  • 1College of Health Sciences, Infectious Diseases Institute, Makerere University, Kampala  Uganda.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 29, 2025
PubMed

Insights

Elevated C-reactive protein (CRP) levels in adults with tuberculous meningitis (TBM), especially those with HIV, indicate a higher risk of poor outcomes. This inflammation marker can predict disease severity and prognosis in TBM patients.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Immunology

Background:

  • Tuberculous meningitis (TBM) is a severe infection with significant morbidity and mortality.
  • HIV co-infection is common in TBM cases, complicating diagnosis and treatment.
  • Predictive biomarkers for TBM prognosis are needed to guide clinical management.

Purpose of the Study:

  • To investigate the prognostic value of C-reactive protein (CRP) in adults with TBM.
  • To assess the association between baseline CRP levels and clinical outcomes at 8 weeks.

Main Methods:

  • A cohort of 135 adults with TBM was enrolled.
  • Baseline CRP levels were measured.
  • Modified Rankin Scale (mRS) scores were assessed at 8 weeks.
  • Statistical analysis was performed to determine the odds of poor outcomes based on CRP levels.

Main Results:

  • 83% of participants were living with HIV.
  • Participants with a baseline CRP ≥40 mg/L had significantly higher odds of an 8-week mRS score ≥4 (aOR, 2.78; 95% CI: 1.28-6.04; P = .010).
  • This association remained significant after adjustment for potential confounders.

Conclusions:

  • C-reactive protein (CRP) is a viable and accessible prognostic biomarker in tuberculous meningitis.
  • Elevated CRP levels at baseline can predict a worse clinical outcome in TBM patients.
  • CRP measurement may aid in identifying high-risk TBM patients requiring closer monitoring and intensified treatment.
Keywords:
C-reactive proteinHIVmeningitistuberculosistuberculous meningitis

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