The Influential Factors Associated With The Prognosis Of Children With Tuberculous Meningitis

Objective: The aim of this study was to determine factors associated with the prognosis of tuberculous meningitis(TBM).Methods: This study was consisted of a retrospective analysis of one hundred and one cases of tuberculous meningitis diagnosed from January 2004 to December 2007 in the Children's Hospital of Chongqing Medical University. The following groups of variables were assessed: sociodemographic data, clinical data and auxiliary examination, treatment and outcome. The patients were divided into three groups: the first group was complete recovery, clinical symptoms and signs all disappeared without neurological sequelae; the secondle group was improved survivor, clinical symptoms and signs didn't completely disappear or survived with neurological sequelae, the third group was death. Make the outcome to be dependent variable and the fifteen potential influential factors to be independent variables. Use the cumulative logit model to do univariate regression analysis at first, p<0.05 was considered to be statistically significant, and then multivariate stepwise regression analysis was performed on outcome with the statistically significant factors with p-to-enter 0.05, p-to-remove 0.1. All analyses were performed using the SAS 8.2 software.Results:Of 101 TBM children, 44 cases(43.6%) were complete recovery, clinical symptoms and signs all disappeared without neurological sequelae; 44 cases(43.6%) were survived with clinical symptoms, signs or neurological sequelae, 13 cases (12.8%) were death. The univariate analysis revealed a significant correlation of ten variables to the prognosis (P<0.05). There were five protective factors: BCG vaccinated (OR=0.453), length of hospital stay (OR=0.229), antituberculous therapy (OR=0.251), adjunctive glucocorticosteroid (OR=0.237), intrathecal injection (OR=0.354). Clinical stage (OR=11.106), convulsion (OR=3.469), limbs-plegia (OR=3.937), conscious disturbance (OR=4.236), hydrocephalus (OR=1.527) were risk factors. Age, cerebrospinal fluid(CSF) protein level, cranial nerve palsy, positive detection of Bacillus tuberculosis, extra cranial tuberculosis were not statistically significant. The multivariate stepwise regression analysis identfied four independent variables associated with prognosis: length of hospital stay (OR=0.188) was protective factor, conscious disturbance (OR=2.147), Clinical stage (OR=10.003), limbs-plegia (OR=4.185) were risk factors. The other factors statistically significant in the univariate analysis had no correlation to the prognosis.Conclusion: TBM continues to be a serious infectious disease of central nervous system with high neurologic morbidity and mortality. The present study documents that in children with TBM the longer length of hospital stay, the better outcome; Clinical stage, conscious disturbance and limbs-plegia were risk factors of neurologic morbidity or mortality. We should emphasis the recognition of TBM. Diagnosis and treatment in early-stage, standard hospitalization and treatment will be important to improve the prognosis.