Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-08-17

AUTHORS

Marie Cantier, Adeline Morisot, Emmanuel Guérot, Bruno Megarbane, Keyvan Razazi, Damien Contou, Eric Mariotte, Emmanuel Canet, Etienne De Montmollin, Vincent Dubée, Eric Boulet, Stéphane Gaudry, Guillaume Voiriot, Julien Mayaux, Frédéric Pène, Mathilde Neuville, Bruno Mourvillier, Stéphane Ruckly, Lila Bouadma, Michel Wolff, Jean-François Timsit, Romain Sonneville,

ABSTRACT

BACKGROUND: Tuberculous meningitis (TBM) is a devastating infection in tuberculosis endemic areas with limited access to intensive care. Functional outcomes of severe adult TBM patients admitted to the ICU in nonendemic areas are not known. METHODS: We conducted a retrospective multicenter cohort study (2004-2016) of consecutive TBM patients admitted to 12 ICUs in the Paris area, France. Clinical, biological, and brain magnetic resonance imaging (MRI) findings at admission associated with a poor functional outcome (i.e., a score of 3-6 on the modified Rankin scale (mRS) at 90 days) were identified by logistic regression. Factors associated with 1-year mortality were investigated by Cox proportional hazards modeling. RESULTS: We studied 90 patients, of whom 61 (68%) had a score on the Glasgow Coma Scale ≤ 10 at presentation and 63 (70%) required invasive mechanical ventilation. Brain MRI revealed infarction and hydrocephalus in 38/75 (51%) and 25/75 (33%) cases, respectively. A poor functional outcome was observed in 55 (61%) patients and was independently associated with older age (adjusted odds ratio (aOR) 1.03, 95% CI 1.0-1.07), cerebrospinal fluid protein level ≥ 2 g/L (aOR 5.31, 95% CI 1.67-16.85), and hydrocephalus on brain MRI (aOR 17.2, 95% CI 2.57-115.14). By contrast, adjunctive steroids were protective (aOR 0.13, 95% CI 0.03-0.56). The multivariable adjusted hazard ratio of adjunctive steroids for 1-year mortality (47%, 95% CI 37%-59%) was 0.23 (95% CI 0.11-0.44). Among survivors at 1 year, functional independence (mRS of 0-2) was observed in 27/37 (73%, 95% CI 59%-87%) cases. CONCLUSIONS: A poor functional outcome in adult TBM patients admitted to the ICU in a nonendemic area is observed in 60% of cases and is independently associated with elevated cerebrospinal fluid protein level and hydrocephalus. Our data also suggest a protective effect of adjunctive steroids, with reduced disability and mortality, irrespective of immune status and severity of disease at presentation. One-year follow-up revealed functional independence in most survivors. More... »

PAGES

210

References to SciGraph publications

Journal

TITLE

Critical Care

ISSUE

1

VOLUME

22

Author Affiliations

  • Department of Neurology, Saint Antoine University Hospital, Assistance Publique—Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75011 Paris, France
  • Department of Public Health, L’Archet Hospital, Nice University Hospital, Nice, France
  • Department of Intensive Care Medicine, Georges Pompidou European Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Intensive Care Medicine and Toxicology, Lariboisière University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Intensive Care Medicine, Henri Mondor University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Intensive Care Medicine, Saint-Louis University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Intensive Care Medicine, Saint-Denis Delafontaine Hospital, Saint-Denis, France
  • Department of Intensive Care Medicine, Saint-Antoine University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Intensive Care Medicine, René Dubos Hospital, Pontoise, France
  • Medical-Surgical Intensive Care Unit, Louis Mourier University Hospital, Assistance Publique—Hôpitaux de Paris, Colombes, France
  • Department of Intensive Care Medicine, Tenon University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Pneumology and Intensive Care Medicine, La Pitié-Salpêtrière University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Intensive Care Medicine, Cochin University Hospital, Assistance Publique—Hôpitaux de Paris, Paris, France
  • Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
  • UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, control and care, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  • UMR 1148, Laboratory for Vascular and Translational Science, INSERM/Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s13054-018-2140-8

    DOI

    http://dx.doi.org/10.1186/s13054-018-2140-8

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1106156054

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30119686


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