TY - JOUR
T1 - Neurological complications after tuberculous meningitis in a multi-state cohort in the United States
AU - Merkler, Alexander E.
AU - Reynolds, Alexandra S.
AU - Gialdini, Gino
AU - Morris, Nicholas A.
AU - Murthy, Santosh B.
AU - Thakur, Kiran
AU - Kamel, Hooman
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/4/15
Y1 - 2017/4/15
N2 - Background and purpose To assess the rate of neurological complications and mortality after tuberculous meningitis in the United States. Methods The authors performed a retrospective cohort study of all patients 18 years or older hospitalized for tuberculous meningitis in California between 2005 and 2010, New York between 2006 and 2012, and Florida between 2005 and 2012. Outcomes of interest were mortality and the following neurological complications: stroke, seizure, hydrocephalus requiring a ventriculoperitoneal shunt, vision impairment, and hearing impairment. Kaplan–Meier survival statistics were used to assess the cumulative rate of neurological complications and death. Cox proportional hazards regression was used to compare rates of complications in patients with and without human immunodeficiency virus (HIV) after adjustment for comorbidities. Results 806 patients with tuberculous meningitis were identified, among whom the cumulative rate of any complication or death was 55.4% (95% CI, 51.5–59.3%). More than two-thirds of complications occurred during the initial hospitalization for tuberculous meningitis. Individual neurological complications were not uncommon: the cumulative rate of stroke was 16.8% (95% CI, 14.0–20.0%), the rate of seizure was 18.8% (95% CI, 15.4–22.8%), and the rate of ventriculoperitoneal shunting was 8.4% (95% CI, 6.4–10.9%). Vision impairment occurred in 21.6% (95% CI, 18.5–25.1%) of patients and hearing impairment occurred in 6.8% (95% CI, 4.9–9.4%). The mortality rate was 21.5% (95% CI, 18.4–24.9%). Patients with HIV infection were not at increased risk of complications compared to patients without HIV (hazard ratio, 1.2; 95% CI, 0.9–1.6). Conclusions Tuberculous meningitis is associated with significant risk of neurological complications and death in the United States.
AB - Background and purpose To assess the rate of neurological complications and mortality after tuberculous meningitis in the United States. Methods The authors performed a retrospective cohort study of all patients 18 years or older hospitalized for tuberculous meningitis in California between 2005 and 2010, New York between 2006 and 2012, and Florida between 2005 and 2012. Outcomes of interest were mortality and the following neurological complications: stroke, seizure, hydrocephalus requiring a ventriculoperitoneal shunt, vision impairment, and hearing impairment. Kaplan–Meier survival statistics were used to assess the cumulative rate of neurological complications and death. Cox proportional hazards regression was used to compare rates of complications in patients with and without human immunodeficiency virus (HIV) after adjustment for comorbidities. Results 806 patients with tuberculous meningitis were identified, among whom the cumulative rate of any complication or death was 55.4% (95% CI, 51.5–59.3%). More than two-thirds of complications occurred during the initial hospitalization for tuberculous meningitis. Individual neurological complications were not uncommon: the cumulative rate of stroke was 16.8% (95% CI, 14.0–20.0%), the rate of seizure was 18.8% (95% CI, 15.4–22.8%), and the rate of ventriculoperitoneal shunting was 8.4% (95% CI, 6.4–10.9%). Vision impairment occurred in 21.6% (95% CI, 18.5–25.1%) of patients and hearing impairment occurred in 6.8% (95% CI, 4.9–9.4%). The mortality rate was 21.5% (95% CI, 18.4–24.9%). Patients with HIV infection were not at increased risk of complications compared to patients without HIV (hazard ratio, 1.2; 95% CI, 0.9–1.6). Conclusions Tuberculous meningitis is associated with significant risk of neurological complications and death in the United States.
KW - Outcome studies
KW - Seizure
KW - Stroke
KW - Tuberculous meningitis
KW - United States
KW - Ventriculoperitoneal shunt
UR - http://www.scopus.com/inward/record.url?scp=85014330625&partnerID=8YFLogxK
U2 - 10.1016/j.jns.2017.02.051
DO - 10.1016/j.jns.2017.02.051
M3 - Article
C2 - 28320186
AN - SCOPUS:85014330625
SN - 0022-510X
VL - 375
SP - 460
EP - 463
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
ER -