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Prognostic models for 9 month mortality in tuberculous meningitis.

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Thao, Le Thi Phuong, Heemskerk, A Dorothee, Geskus, Ronald B, Mai, Nguyen Thi Hoang, Ha, Dang Thi Minh, Chau, Tran Thi Hong, Phu, Nguyen Hoan, Chau, Nguyen Van Vinh, Caws, Maxine ORCID: https://orcid.org/0000-0002-9109-350X, Lan, Nguyen Huu, Thu, Do Dang Anh, Thuong, Nguyen Thuy Thuong, Day, Jeremy, Farrar, Jeremy J, Torok, M Estee, Bang, Nguyen Duc, Thwaites, Guy E and Wolbers, Marcel (2018) 'Prognostic models for 9 month mortality in tuberculous meningitis.'. Clinical Infectious Diseases, Vol 66, Issue 4, pp. 523-532.

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Abstract

Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis. We developed and validated prognostic models for 9-month mortality in HIV-uninfected and HIV-infected adults with TBM. We included 1699 subjects from four randomized clinical trials and one prospective observational study conducted at two major referral hospitals in Southern Vietnam from 2001-2015. Modelling was based on multivariable Cox proportional hazards regression. The final prognostic models were validated internally and temporally, and displayed using nomograms and a web-based app (https://thaole.shinyapps.io/tbmapp/). A total of 951 HIV-uninfected and 748 HIV-infected subjects with TBM were included, of whom 219/951 (23.0%) and 384/748 (51.3%) died during 9-month follow-up. Common predictors for increased mortality in both populations were higher Medical Research Council (MRC) disease severity grade and lower cerebrospinal fluid lymphocyte cells count. In HIV-uninfected subjects, older age, previous tuberculosis, not receiving adjunctive dexamethasone, and focal neurological signs were additional risk factors; in HIV-infected subjects, lower weight, lower peripheral blood CD4 cell count, and abnormal plasma sodium were additional risk factors. The areas under the receiver operating characteristic curves (AUCs) for the final prognostic models were 0.77 (HIV-uninfected population) and 0.78 (HIV-infected population), demonstrating markedly better discrimination than the MRC grade (AUC 0.66 and 0.70) or the Glasgow Coma Score (AUC 0.68 and 0.71) alone. The developed models showed good performance and could be used in clinical practice to assist doctors in identifying TBM patients at high risk of death and at increased need of supportive care.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 245 Meningococcal infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WK Endocrine System > WK 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1093/cid/cix849
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 31 Oct 2017 12:19
Last Modified: 15 Jun 2018 14:53
URI: https://archive.lstmed.ac.uk/id/eprint/7744

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