Mortality Predictors of Adult Meningeal Tuberculosis: Analysis from a Tertiary Center Using the Lancet Consensus...

Compared with other types of central nervous system tuberculosis (TB), meningeal TB has a greater fatality rate. However, data on mortality predictors are limited. This study aimed to determine predictors of mortality in patients with meningeal TBM.

This was a hybrid retrospective-prospective (ambispective) study, in which data were collected retrospectively for patients admitted between January 2019 and December 2020 and prospectively for patients admitted between January 2021 and March 2022.

We conducted an ambispective cohort study of 132 adults (>18 years) with suspected meningitis admitted to the All India Institute of Medical Sciences, Rishikesh, India, between January 2019 and March 2022. Patients were classified as having definite, probable, or possible tuberculous meningitis (TBM) using the Lancet Consensus case definition. The primary outcome was in-hospital mortality. Univariable and multivariable Cox proportional-hazards models were used to identify predictors.

Of the 132 patients enrolled in the study, 66 were classified as having definitive TBM, 12 as probable TBM, 21 as possible TBM, and 33 as non-TBM. The overall mortality rate among patients with any form of TBM (definitive, probable, or possible) was 37.87% (25 deaths), with the highest mortality observed in the definitive TBM group, accounting for 32.3% of deaths (21 cases). Fever, altered sensorium, high serum neutrophil count, low serum lymphocyte count, high CSF lymphocyte count, and low CSF neutrophil count were significantly associated (p<0.05) with the variable definitive TBM as a predictor of mortality in our study.

Simple hematological and CSF parameters can help stratify risk in TBM. These markers may guide early clinical decisions and closer monitoring.