Association Between Polymorphonuclear Leukocyte Cell Percentage in Cerebrospinal Fluid and Outcome of Tuberculous Meningitis Patients in a Tertiary Hospital in Indonesia

Abstract

Tuberculous (TB) meningitis is the most severe type of extrapulmonary TB with high morbidity and mortality rates. Many factors affect patient outcome, including the intracranial inflammation process. In acute inflammation, recruitment of a high number of polymorphonuclear (PMN) cells can cause edema which may eventually increase the intracranial pressure. This increase in intracranial pressure may lead to functional decline, disability, and even death. This study aimed to explore the association between the PMN percentage in cerebrospinal fluid (CSF) and TB meningitis patient outcome as measured by the Glasgow Outcome Scale at Dr. Hasan Sadikin General Hospital Bandung, which is a tertiary hospital in Indonesia. This was a retrospective cohort study using patient medical record data from 2017. All TB meningitis patients over 18 years old were included. Patients with missing PMN results in medical record were excluded, which led to a total 88 subjects participating in this study. Variables analyzed were PMN percentage in CSF and patient outcome that were categorized as poor, moderate, and good. Analysis were performed using theKruskal-wallis test. An increase in PMN median as the patient outcome declined were observed, but the association between the PMN percentage in CSF and patient outcome was insignificant (p=0.186). Hence, no association between PMN percentage in CSF and TB meningitis patient outcome was identified in this study.