Tuberculous meningitis: do modern diagnostic tools offer better prognosis prediction?

BACKGROUND: The British Medical Research Council (BMRC) staging has been extensively used to evaluate the disease severity and establish the approximate prognosis of tuberculous meningitis.

AIMS: This study aimed at analyzing the predictive accuracy for mortality and neurological sequelae of a set of clinical features, laboratory tests and imaging.

METHODS: We compared the British Medical Research Council (BMRC) staging with a new scoring proposal to predict the prognosis of patients with Central Nervous System Tuberculosis. Data from Ecuador was collected. A score was built using a Spiegelhalter and Knill-Jones method and compared with BMRC staging with a ROC curve.

RESULTS: A total of 213/310 patients (68.7%) were in BMRC stage II or III. Fifty-seven patients died (18.3%) and 101 (32.5%) survived with sequelae. The associated predictors were consciousness impairment (p = 0.010), motor deficit (p = 0.003), cisternal effacement (p = 0.006) and infarcts (p = 0.015). The new score based on these predictors yielded a larger area under the curve of 0.76 (95% CI: 0.70-0.82), but not significantly different from the BMRC (0.72: 95% CI: 0.65-0.77).

CONCLUSIONS: This modern score is easy to apply and could be a sound predictor of poor prognosis. However, the availability of modern tests did not improve the ability to predict a bad outcome.