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ORIGINAL ARTICLE
HIV–A prognostic factor of tuberculous meningitis: A retrospective cohort study among adults in peninsular Malaysia
1
Sultan Azlan Shah Training Institute of Ministry of Health Malaysia, Ministry of Health Malaysia, Perak, MALAYSIA
2
Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, MALAYSIA
3
Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, MALAYSIA
4
Department of Neurosciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
5
Department of Neurology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Wilayah Persekutuan, Kuala Lumpur, MALAYSIA
6
Department of Respiratory, Hospital Pulau Pinang, Ministry of Health Malaysia, Pulau Pinang, MALAYSIA
7
Department of Respiratory, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, MALAYSIA
8
Pharmacology Unit, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor Darul Ehsan, MALAYSIA
9
Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, 600077, INDIA
10
Faculty of Health and Life Sciences, INTI International University, Nilai, MALAYSIA
11
Faculty of Dentistry, AIMST University, Bedong, Kedah, MALAYSIA
12
Centre for Global Health Research, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, INDIA
Publication date: 2024-03-25
Electron J Gen Med 2024;21(2):em579
KEYWORDS
ABSTRACT
Background:
Tuberculous meningitis is a major public health issue, despite showing low incidence, tuberculous meningitis causes substantial mortality. For better clinical management, identification of prognostic factors is crucial to reduce health risk of Malaysian society. Therefore, the aim of this study was to determine the prognostic factors of adult tuberculous meningitis in peninsular Malaysia.
Materials & methods:
Initially, a retrospective cohort study and one-year of follow-up period was carried out. In addition, a total of 217 adult tuberculous meningitis patients treated or had follow-up in four tertiary hospitals in peninsular Malaysia were recruited. Cox proportional hazards regression was employed to perform multivariable analysis.
Results:
The overall survival probability of adult tuberculous meningitis was 36.8% with median survival time 244 days. Significant prognostic factors were Glasgow coma scale score (aHR=0.71, 95% CI=0.65, 0.76; p<0.001), HIV status (aHR=1.94, 95% confidence interval [CI]=1.19, 3.15; p=0.008), headache (aHR=0.48, 95% CI=0.31, 0.76; p=0.002) and meningeal enhancement (aHR=0.47, 95% CI=0.30, 0.74; p=0.001), nausea (aHR=2.21, 95% CI=1.33, 3.66; p=0.002), and vomit (aHR=0.58, 95% CI=0.36, 0.93; p=0.023).
Conclusions:
Evidently, the survival of among adults with tuberculous meningitis was low. Since HIV positive has a significant influence in mortality; early screening, diagnosis, and prompt treatment in this subgroup of patients play a key role in survival.
Tuberculous meningitis is a major public health issue, despite showing low incidence, tuberculous meningitis causes substantial mortality. For better clinical management, identification of prognostic factors is crucial to reduce health risk of Malaysian society. Therefore, the aim of this study was to determine the prognostic factors of adult tuberculous meningitis in peninsular Malaysia.
Materials & methods:
Initially, a retrospective cohort study and one-year of follow-up period was carried out. In addition, a total of 217 adult tuberculous meningitis patients treated or had follow-up in four tertiary hospitals in peninsular Malaysia were recruited. Cox proportional hazards regression was employed to perform multivariable analysis.
Results:
The overall survival probability of adult tuberculous meningitis was 36.8% with median survival time 244 days. Significant prognostic factors were Glasgow coma scale score (aHR=0.71, 95% CI=0.65, 0.76; p<0.001), HIV status (aHR=1.94, 95% confidence interval [CI]=1.19, 3.15; p=0.008), headache (aHR=0.48, 95% CI=0.31, 0.76; p=0.002) and meningeal enhancement (aHR=0.47, 95% CI=0.30, 0.74; p=0.001), nausea (aHR=2.21, 95% CI=1.33, 3.66; p=0.002), and vomit (aHR=0.58, 95% CI=0.36, 0.93; p=0.023).
Conclusions:
Evidently, the survival of among adults with tuberculous meningitis was low. Since HIV positive has a significant influence in mortality; early screening, diagnosis, and prompt treatment in this subgroup of patients play a key role in survival.
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