Mortality predictors and diagnostic challenges in adult tuberculous meningitis: a retrospective cohort of 100 patients.

Objective: This study aimed to assess the clinical characteristics, diagnostic certainty, outcomes, and predictors of mortality in patients diagnosed with tuberculous meningitis (TBM), using the Lancet scoring system for diagnostic certainty.

Methods: A retrospective cohort was conducted on 100 patients diagnosed with TBM. Patients were classified based on the Lancet scoring system into definite, probable, and possible TBM categories. Clinical features, neuroimaging findings, cerebrospinal fluid (CSF) analysis, and outcomes were analyzed.

Results: The median age of patients was 36.5 years, with 57.0% male. The most common symptoms were fever (64.7%), headache (63.6%), and altered consciousness (60.0%). Hydrocephalus was present in 40.0% of cases. Diagnosis certainty was classified as possible (63.0%), probable (22.0%), and definite (15.0%). The in-hospital mortality rate was 18.0%, with 12-month survival rates of 69.7%. There was no significant difference between the level of diagnostic certainty and the survival of patients. Significant predictors of mortality included hydrocephalus (hazard ratio [HR]: 3.65, 95% CI 1.67 to 7.97), hemoglobin levels (HR: 0.75, 95% CI 0.64 to 0.89), age (HR: 1.04, 95% CI 1.02 to 1.06), CSF pleocytosis (HR: 0.34, 95% CI 0.14 to 0.84), and altered consciousness at admission (HR: 19.23, 95% CI 2.57 to 143.85).

Conclusion: TBM remains a critical concern with significant mortality and morbidity. Key predictors of mortality, including altered consciousness, hydrocephalus, and older age, highlight the need for early detection and tailored interventions. In most cases, the diagnosis cannot be definitively confirmed and is instead categorized as probable or possible. Our study demonstrates that survival rates were comparable across definite, probable, and possible TBM categories, supporting the value of empirical treatment when definitive confirmation is not feasible.