Systemic Inflammation Predict Neurological Functional Outcome in Patients with Tuberculous Meningitis: A Multicenter Retrospective Cohort Study in China

Yijia Guo; Ruyun Zhang; Xinling Gan; Erli Wang; Shuihua Lu; Hui Jiang; Hongfei Duan; Zhengzhou Yuan; Weimin Li; Yong Liu

doi:10.2147/JIR.S489495

Systemic Inflammation Predict Neurological Functional Outcome in Patients with Tuberculous Meningitis: A Multicenter Retrospective Cohort Study in China

J Inflamm Res. 2024 Oct 22:17:7561-7571. doi: 10.2147/JIR.S489495. eCollection 2024.

Authors

Yijia Guo^#^{1

2

3}, Ruyun Zhang^#⁴, Xinling Gan⁵, Erli Wang⁶, Shuihua Lu⁷, Hui Jiang³, Hongfei Duan⁸, Zhengzhou Yuan⁹, Weimin Li^{2

3

10}, Yong Liu¹

Affiliations

¹ Department of Neurology, Chengdu Medical College, The First Affiliated Hospital, Chengdu, People's Republic of China.
² Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, People's Republic of China.
³ Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China.
⁴ Department of Emergency, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China.
⁵ Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
⁶ Department of Radiology, The First People's Hospital of Longquanyi District, Chengdu, People's Republic of China.
⁷ National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, People's Republic of China.
⁸ Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People's Republic of China.
⁹ Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China.
¹⁰ National Tuberculosis Clinical Laboratory of China, Beijing Key Laboratory in Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Background: The predictors associated with clinical outcomes in patients with tuberculous meningitis (TBM) remain unclear. We aimed to analyse the relationship between systemic inflammation and clinical outcomes, as well as to explore whether systemic inflammation level influences the effectiveness of dexamethasone on treatment.

Methods: Between January 2011 and December 2021, TBM patients admitted to five hospitals were observed consecutively. Baseline and post-treatment systemic inflammation levels were calculated using the neutrophil-lymphocyte-ratio (NLR). Generalized linear mixed models were employed to identify predictors of clinical outcomes. Propensity score matching and subgroup analyses were conducted to evaluate the effect of dexamethasone on treatment outcomes across different NLR levels.

Results: A total of 1203 TBM patients were included in the study. During the follow-up, 144 (13.6%) participants experienced early neurological deterioration within 7 days after admission, and 345 (28.67%) exhibited poor functional outcome at the 12-month follow-up. Multivariate analysis revealed that post-treatment NLR was significantly associated with early neurological deterioration (OR=1.25; 95% CI, 1.14-1.33; P<0.001), and poor outcome (OR=1.34; 95% CI, 1.26-1.45; P<0.001). After propensity score matching, dexamethasone treatment was not associated with early neurological deterioration (OR=0.83; 95% CI, 0.42-1.66; P=0.610) or poor outcome (OR=1.22; 95% CI, 0.49-2.11; P=0.490) in the highest quartile of post-treatment NLR. The effect of dexamethasone on treatment outcomes did not significantly vary with disease severity stratification.

Conclusion: Elevated systemic inflammation is an independent risk factor for neurological outcome in TBM patients. Further studies are required to investigate systemic inflammation in more severely affected population to better predict the outcomes following anti-inflammatory therapies.

Keywords: neurological outcome; systemic inflammation; tuberculous meningitis.