Clinical predictors of treatment outcome in adult Tuberculous Meningitis patients at the Kundiawa General Hospital

Abstract

AbstractBackgroundTuberculous meningitis is the most severe form of extrapulmonary TB and accounted for 5 % of 10 million TB cases globally in the WHO 2018 report, with mortality as high as 19.35% in children and 30% in adults. Clinicians in resource-poor settings are often challenged with limited diagnostic and therapeutic options for optimal patient care, and often rely on clinical parameters for diagnosis, treatment, monitoring and outcome prediction.AimThis study was done to identify potential clinical predictors of i) length of in-hospital stay, and ii) death or discharge at 28 days, amongst Melanesian adults with TB meningitis at the Kundiawa General Hospital in Simbu Province of Papua New Guinea.MethodA retrospective observational study was conducted on 65 Melanesian adults with TB meningitis at the Kundiawa General Hospital in Simbu province between 2015 and 2019.ResultHigh case fatality (48%) and mortality rates (2.22 per 100,000 per year) for TB Meningitis in this study. Even higher case fatality of 90.9% with HIV co-infection. Parameters associated with higher 28-day mortality included admission GCS (P=0.039, 95% CI), HIV-TBM co-infection (P=0.049, 95% CI), positive fluid balance 24 hours after admission (P=0.061, 95% CI) and male gender (P=0.057, 95% CI).ConclusionStudy showed high case fatality (48%) and mortality rates (2.22 per 100,000 per year) for adult TB Meningitis, with even higher case fatality (90.9%) for HIV-TB co-infection. Admission GCS, positive fluid balance 24 hours after admission, HIV-TB co-infection and male gender were associated with higher 28-day mortality.