Cargando…

Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China

BACKGROUND: Tuberculous meningitis (TBM) is the most lethal form of tuberculosis worldwide. Data on critically ill TBM patients in the intensive care unit (ICU) of China are lacking. We tried to identify prognostic factors of adult TBM patients admitted to ICU in China. METHODS: We conducted a retro...

Descripción completa

Detalles Bibliográficos
Autores principales: Feng, Baobao, Fei, Xiao, Sun, Ying, Zhang, Xingguo, Shang, Deya, Zhou, Yi, Sheng, Meiyan, Xu, Jiarui, Zhang, Wei, Ren, Wanhua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353730/
https://www.ncbi.nlm.nih.gov/pubmed/34376174
http://dx.doi.org/10.1186/s12883-021-02340-3
_version_ 1783736463427371008
author Feng, Baobao
Fei, Xiao
Sun, Ying
Zhang, Xingguo
Shang, Deya
Zhou, Yi
Sheng, Meiyan
Xu, Jiarui
Zhang, Wei
Ren, Wanhua
author_facet Feng, Baobao
Fei, Xiao
Sun, Ying
Zhang, Xingguo
Shang, Deya
Zhou, Yi
Sheng, Meiyan
Xu, Jiarui
Zhang, Wei
Ren, Wanhua
author_sort Feng, Baobao
collection PubMed
description BACKGROUND: Tuberculous meningitis (TBM) is the most lethal form of tuberculosis worldwide. Data on critically ill TBM patients in the intensive care unit (ICU) of China are lacking. We tried to identify prognostic factors of adult TBM patients admitted to ICU in China. METHODS: We conducted a retrospective study on adult TBM in ICU between January 2008 and April 2018. Factors associated with unfavorable outcomes at 28 days were identified by logistic regression. Factors associated with 1-year mortality were studied by Cox proportional hazards modeling. RESULTS: Eighty adult patients diagnosed with TBM (age 38.5 (18–79) years, 45 (56 %) males) were included in the study. An unfavorable outcome was observed in 39 (49 %) patients and were independently associated with Acute Physiology and Chronic Health Evaluation (APACHE) II > 23 (adjusted odds ratio (aOR) 5.57, 95 % confidence interval (CI) 1.55–19.97), Sequential Organ Failure Assessment (SOFA) > 8 (aOR 9.74, 95 % CI 1.46–64.88), and mechanical ventilation (aOR 18.33, 95 % CI 3.15–106.80). Multivariate Cox regression analysis identified two factors associated with 1-year mortality: APACHE II > 23 (adjusted hazard ratio (aHR) 4.83; 95 % CI 2.21–10.55), and mechanical ventilation (aHR 9.71; 95 % CI 2.31–40.87). CONCLUSIONS: For the most severe adult TBM patients of Medical Research Council (MRC) stage III, common clinical factors aren’t effective enough to predict outcomes. Our study demonstrates that the widely used APACHE II and SOFA scores on admission can be used to predict short-term outcomes, while APACHE II could also be used to predict long-term outcomes of adult patients with TBM in ICU. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-021-02340-3.
format Online
Article
Text
id pubmed-8353730
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-83537302021-08-10 Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China Feng, Baobao Fei, Xiao Sun, Ying Zhang, Xingguo Shang, Deya Zhou, Yi Sheng, Meiyan Xu, Jiarui Zhang, Wei Ren, Wanhua BMC Neurol Research Article BACKGROUND: Tuberculous meningitis (TBM) is the most lethal form of tuberculosis worldwide. Data on critically ill TBM patients in the intensive care unit (ICU) of China are lacking. We tried to identify prognostic factors of adult TBM patients admitted to ICU in China. METHODS: We conducted a retrospective study on adult TBM in ICU between January 2008 and April 2018. Factors associated with unfavorable outcomes at 28 days were identified by logistic regression. Factors associated with 1-year mortality were studied by Cox proportional hazards modeling. RESULTS: Eighty adult patients diagnosed with TBM (age 38.5 (18–79) years, 45 (56 %) males) were included in the study. An unfavorable outcome was observed in 39 (49 %) patients and were independently associated with Acute Physiology and Chronic Health Evaluation (APACHE) II > 23 (adjusted odds ratio (aOR) 5.57, 95 % confidence interval (CI) 1.55–19.97), Sequential Organ Failure Assessment (SOFA) > 8 (aOR 9.74, 95 % CI 1.46–64.88), and mechanical ventilation (aOR 18.33, 95 % CI 3.15–106.80). Multivariate Cox regression analysis identified two factors associated with 1-year mortality: APACHE II > 23 (adjusted hazard ratio (aHR) 4.83; 95 % CI 2.21–10.55), and mechanical ventilation (aHR 9.71; 95 % CI 2.31–40.87). CONCLUSIONS: For the most severe adult TBM patients of Medical Research Council (MRC) stage III, common clinical factors aren’t effective enough to predict outcomes. Our study demonstrates that the widely used APACHE II and SOFA scores on admission can be used to predict short-term outcomes, while APACHE II could also be used to predict long-term outcomes of adult patients with TBM in ICU. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-021-02340-3. BioMed Central 2021-08-10 /pmc/articles/PMC8353730/ /pubmed/34376174 http://dx.doi.org/10.1186/s12883-021-02340-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Feng, Baobao
Fei, Xiao
Sun, Ying
Zhang, Xingguo
Shang, Deya
Zhou, Yi
Sheng, Meiyan
Xu, Jiarui
Zhang, Wei
Ren, Wanhua
Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China
title Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China
title_full Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China
title_fullStr Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China
title_full_unstemmed Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China
title_short Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China
title_sort prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in east china
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353730/
https://www.ncbi.nlm.nih.gov/pubmed/34376174
http://dx.doi.org/10.1186/s12883-021-02340-3
work_keys_str_mv AT fengbaobao prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT feixiao prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT sunying prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT zhangxingguo prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT shangdeya prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT zhouyi prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT shengmeiyan prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT xujiarui prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT zhangwei prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina
AT renwanhua prognosticfactorsofadulttuberculousmeningitisinintensivecareunitasinglecenterretrospectivestudyineastchina