Outcomes in Patients with Tuberculous Meningitis: A Prospective Cohort Study in North India.

Abstract

Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis, carrying the highest mortality among all forms. This multicentric prospective cohort study conducted in North India aimed to determine the incidence of complications, functional outcome (modified Rankin scale [mRS]), and mortality in TBM. Patients 12 years old and older with TBM were followed up until completion of 9 months of antitubercular treatment. Patients with concomitant HIV infection, other infections causing meningitis, or multidrug-resistant tuberculosis were excluded. The primary outcome was mRS at 9 months. Secondary outcomes included mRS at 6 months, poor mRS (>2), Barthel Index, and mortality at 6 and 9 months. Between October 1, 2019 and March 31, 2024, 585 eligible patients were enrolled, of whom 495 (84.6%) completed follow-up. The median age was 24.0 years old, and the majority were female (n = 304/495; 61.4%). Complications were present in 377 patients (76.2%): focal neurological deficits (41.6%), seizures (38.6%), immune reconstitution inflammatory syndrome (32.7%), hydrocephalus (24.8%), and drug-induced liver injury (14.1%). Complications were associated with worse mRS on unadjusted analysis (odds ratio [OR]: 2.5 [1.7-3.7]; P <0.001); however, this association was no longer statistically significant after adjustment for age, sex, baseline mRS, study center, and disease stage and category (OR: 1.3 [0.8-2.0]; P = 0.30). The median mRS improved from 4.0 at presentation to 2.0 at 6 months and 1.0 at 9 months. Death occurred at a median of 91.0 days after presentation. Mortality at 6 months was 9.3% and at 9 months was 10.7%.