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

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 co...

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Main 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, ENCEPHALITICA study group
Format: Article
Language:English
Published: BMC 2018-08-01
Series:Critical Care
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13054-018-2140-8
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author 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
ENCEPHALITICA study group
spellingShingle 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
ENCEPHALITICA study group
Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study
Critical Care
Tuberculous meningitis
Steroids
Intensive care
Functional outcomes
author_facet 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
ENCEPHALITICA study group
author_sort Marie Cantier
title Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study
title_short Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study
title_full Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study
title_fullStr Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study
title_full_unstemmed Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort study
title_sort functional outcomes in adults with tuberculous meningitis admitted to the icu: a multicenter cohort study
publisher BMC
series Critical Care
issn 1364-8535
publishDate 2018-08-01
description 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.
topic Tuberculous meningitis
Steroids
Intensive care
Functional outcomes
url http://link.springer.com/article/10.1186/s13054-018-2140-8
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spelling doaj-8c16a77952ad43d19a58702b83835c1c2020-11-25T01:36:06ZengBMCCritical Care1364-85352018-08-012211810.1186/s13054-018-2140-8Functional outcomes in adults with tuberculous meningitis admitted to the ICU: a multicenter cohort studyMarie Cantier0Adeline Morisot1Emmanuel Guérot2Bruno Megarbane3Keyvan Razazi4Damien Contou5Eric Mariotte6Emmanuel Canet7Etienne De Montmollin8Vincent Dubée9Eric Boulet10Stéphane Gaudry11Guillaume Voiriot12Julien Mayaux13Frédéric Pène14Mathilde Neuville15Bruno Mourvillier16Stéphane Ruckly17Lila Bouadma18Michel Wolff19Jean-François Timsit20Romain Sonneville21ENCEPHALITICA study groupDepartment of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Public Health, L’Archet Hospital, Nice University HospitalDepartment of Intensive Care Medicine, Georges Pompidou European Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine and Toxicology, Lariboisière University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, Henri Mondor University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, Henri Mondor University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, Saint-Louis University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, Saint-Louis University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, Saint-Denis Delafontaine HospitalDepartment of Intensive Care Medicine, Saint-Antoine University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, René Dubos HospitalMedical-Surgical Intensive Care Unit, Louis Mourier University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, Tenon University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Pneumology and Intensive Care Medicine, La Pitié-Salpêtrière University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine, Cochin University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de ParisUMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, control and care, INSERM/Université Paris Diderot, Sorbonne Paris CitéDepartment of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de ParisDepartment of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique—Hôpitaux de ParisAbstract 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.http://link.springer.com/article/10.1186/s13054-018-2140-8Tuberculous meningitisSteroidsIntensive careFunctional outcomes