Risk Factors Associated with Mortality among TBMPatients - 9 Month Follow Up

Abstract

Introduction: Bangladesh has a high prevalence of both pulmonary and extra pulmonary TB. TBM is a significant public health concern in our nation. Finding prognostic indicators would enhance therapeutic effectiveness and ultimately stop long-term mortality and morbidity.Many factors contribute to the high mortality rate among TBM patients, both independently and in association with other factors. The present study was conducted to observe and recognize such risk factors for mortality. Aim of the study: The aim of the study was to observe the risk factors of mortality among TBM patients. Methods: This hospital-based prospective cohort study was carried out at the Inpatient Department of Clinical Neurology at the National Institute of Neurosciences & Hospital (NINS & H), Dhaka, Bangladesh from October 2016 to September 2017, 1 year. A total of 54 patients admitted to the hospital with features of Tuberculous Meningitis (TBM) were selected for the study following inclusion and exclusion criteria. Result: Over 70% of patients were adolescents or young adults with a mean age of 28.2 ± 12.3 years. The majority (48.2%) of the participants were from TBM Stage II, while 37% were from Stage III of TBM. Fever, headache, and systematic symptoms were the most frequent clinical presentations. The study found several risk factors for mortality in patients with TBM, including age over 50, duration of illness over 45 days, convulsion, altered sensorium, and treatment delay over 1 month. However, when these factors were analyzed together in a multivariate model, their significance decreased. Age over 50, duration of illness over 45 days, convulsion, altered sensorium, and treatment delay had a relative risk of 0.9, 0.3, 2.2, 2.3 and 1.3 respectively with a p-value of 0.488, 0.244, 0.051, 0.036, and 0.043 respectively. Stage III TBM had a relative risk of 3.6 with a p-value of 0.004. These factors were significant risk factors for mortality in TBM patients but when analyzed together, their significance decreases. Conclusion: In univariate analysis, age >50 years, duration of illness (> 45 d), convulsion, altered sensorium, treatment delay > 1 month, and stage III TBM were significantly associated with TBM mortality. Ultimately, stage III TBM, altered sensorium, and treatment delay > 1 month were found as independent predictors of mortality in multivariate analyses.