The risk factors for mortality in children with tuberculous meningitis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Wenlu ¹ ,  WAN Bin ² , ZHAO Xia ² , XIE Peng ¹ , YAO Rong ² , LV Mengyu ² , WU Chuntao ² , LEI Limei ²

1. Chengdu University of Traditional Chinese medicine, Chengdu 610036, P. R. China;
2. Chengdu Public Health Clinical Medical Center, Chengdu 610011, P. R. China;

Corresponding author：

WAN Bin, Email: 673971566@qq.com

Keywords：

Children; Tuberculous meningitis; Death; Risk factors; Meta-analysis

DOI：

10.7507/1672-2531.202211168

Video：

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Objective To systematically review the risk factors for death in children with tuberculous meningitis (TBM). Methods The CNKI, VIP, WanFang Data, CBM, Cochrane Library, Web of Science, PubMed, EMbase and CINAHL databases were electronically searched to collect studies on the risk factors for death in children with TBM from inception to October 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 15 studies involving 2 597 patients were included. The results of meta-analysis showed that male (OR=2.41, 95%CI 1.61 to 3.61, P<0.01), no history of BCG vaccination (OR=3.74, 95%CI 1.96 to 7.12, P<0.01), TBM stage (stage Ⅲ) (OR=2.04, 95%CI 1.26 to 3.28, P<0.01), HIV infection (OR=3.28, 95%CI 1.20 to 8.93, P=0.02), convulsion (OR=3.61, 95%CI 3.31 to 3.94, P<0.01), disturbance of consciousness (OR=3.58, 95%CI 2.40 to 5.34, P<0.01), cerebrospinal fluid protein concentration increased (OR=1.87, 95%CI 1.39 to 2.51, P<0.01), hydrocephalus (OR=2.44, 95%CI 1.60 to 3.71, P<0.01) and short hospitalization (OR=2.89, 95%CI 2.05 to 4.06, P<0.01) were risk factors for death in children with TBM. Under 5 years old, negative PPD skin test, positive meningeal irritation sign, malnutrition and history of contact with TB may not be associated with the death of TBM in children. Conclusion Male, no history of BCG vaccination, TBM stage (stage Ⅲ), HIV infection, convulsions, disturbance of consciousness, cerebrospinal fluid protein concentration increased, hydrocephalus and short hospitalization are risk factors for death in children with TBM. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： YANG Wenlu, WAN Bin, ZHAO Xia, XIE Peng, YAO Rong, LV Mengyu, WU Chuntao, LEI Limei. The risk factors for mortality in children with tuberculous meningitis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(8): 894-900. doi: 10.7507/1672-2531.202211168 Copy

1.	朱会. 88例儿童结核性脑膜炎临床特点、类赫氏反应及预后危险因素分析. 遵义: 遵义医科大学, 2020.
2.	姚雪华. 儿童结核性脑膜炎预后及相关危险因素分析. 中国实用神经疾病杂志, 2019, 22(9): 1006-1012.
3.	陈理雪, 舒敏. 儿童结核性脑膜炎与营养不良的关系及营养支持. 实用医院临床杂志, 2019, 16(3): 240-242.
4.	Huynh J, Abo YN, du Preez K, et al. Tuberculous meningitis in children: reducing the burden of death and disability. Pathogens, 2021, 11(1): 38.
5.	Chiang SS, Khan FA, Milstein MB, et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis, 2014, 14(10): 947-957.
6.	Rahimi BA, Niazi N, Rahimi AF, et al. Treatment outcomes and risk factors of death in childhood tuberculous meningitis in Kandahar, Afghanistan: a prospective observational cohort study. Trans R Soc Trop Med Hyg, 2022, 116(12): 1181-1190.
7.	Paganini H, Gonzalez F, Santander C, et al. Tuberculous meningitis in children: clinical features and outcome in 40 cases. Scand J Infect Dis, 2000, 32(1): 41-45.
8.	Nataprawira HM, Gafar F, Risan NA, et al. Treatment outcomes of childhood tuberculous meningitis in a real-world retrospective cohort, Bandung, Indonesia. Emerg Infect Dis, 2022, 28(3): 660-671.
9.	Israni AV, Dave DA, Mandal A, et al. Tubercular meningitis in children: clinical, pathological, and radiological profile and factors associated with mortality. J Neurosci Rural Pract, 2016, 7(3): 400-404.
10.	Jadaun P, Patil R, Ramteke S, et al. A study to assess the clinico-radiological presentation and outcome predictors in cases of tubercular meningitis. Indian J Tuberc, 2021, 68(3): 384-388.
11.	Kelekçi S, Karabel M, Karabel D, et al. Bacillus Calmette-Guérin is a preventive factor in mortality of childhood tuberculous meningitis. Int J Infect Dis, 2014, 21: 1-4.
12.	Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis, 2010, 10(11): 803-812.
13.	李沪生, 黄凤, 高玉婷, 等. 术前不同糖化血红蛋白水平对成人心脏手术患者预后影响的Meta分析. 中国全科医学, 2022, 25(17): 2135-2144.
14.	邹丹. 儿童结核性脑膜炎临床特点及死亡危险因素分析. 重庆: 重庆医科大学, 2014.
15.	宋承平, 吴吉丽, 罗宏. 儿童结核性脑膜炎34例临床分析. 中国药物与临床, 2017, 17(5): 715-716.
16.	幸琳琳, 解元元, 朱朝敏. 卡介苗接种预防儿童结核性脑膜炎回顾研究. 中国实用儿科杂志, 2009, 24(6): 469-470, 473.
17.	Topley JM, Bamber S, Coovadia HM, et al. Tuberculous meningitis and co-infection with HIV. Ann Trop Paediatr, 1998, 18(4): 261-266.
18.	Seddon JA, Visser DH, Bartens M, et al. Impact of drug resistance on clinical outcome in children with tuberculous meningitis. Pediatr Infect Dis J, 2012, 31(7): 711-716.
19.	Karande S, Gupta V, Kulkarni M, et al. Prognostic clinical variables in childhood tuberculous meningitis: an experience from Mumbai, India. Neurol India, 2005, 53(2): 191-195.
20.	Bang ND, Caws M, Truc TT, et al. Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study. BMC Infect Dis, 2016, 16(1): 573.
21.	Salih R, van Toorn R, Seddon JA, et al. The impact of hyponatremia on the severity of childhood tuberculous meningitis. Front Neurol, 2022, 12: 703352.
22.	Carranza C, Carreto-Binaghi LE, Guzmán-Beltrán S, et al. Sex-dependent differential expression of lipidic mediators associated with inflammation resolution in patients with pulmonary tuberculosis. Biomolecules, 2022, 12(4): 490.
23.	Syggelou A, Spyridis N, Benetatou K, et al. BCG vaccine protection against TB infection among children older than 5 years in close contact with an infectious adult TB case. J Clin Med, 2020, 9(10): 3224.
24.	Seddon JA, Wilkinson R, van Crevel R, et al. Knowledge gaps and research priorities in tuberculous meningitis. Wellcome Open Res, 2019, 4: 188.
25.	Daniel BD, Grace GA, Natrajan M. Tuberculous meningitis in children: clinical management & outcome. Indian J Med Res, 2019, 150(2): 117-130.
26.	Seid G, Alemu A, Dagne B, et al. Microbiological diagnosis and mortality of tuberculosis meningitis: systematic review and meta-analysis. PLoS One, 2023, 18(2): e0279203.
27.	杨妮, 苏茜, 肖月, 等. 2158例MTB/HIV双重感染患者治疗转归及影响因素分析. 中国防痨杂志, 2021, 43(3): 274-279.
28.	杨汝铃, 龙晓茹, 张祯祯, 等. 222例儿童结核性脑膜炎的临床特征及其预后影响因素分析. 中国防痨杂志, 2020, 42(10): 1053-1060.
29.	Wang MS, Zhao M, Liu XJ. Risk factors for poor outcome in childhood tuberculous meningitis. Sci Rep, 2021, 11(1): 8654.
30.	Manyelo CM, Chegou NN, Seddon JA, et al. Serum and cerebrospinal fluid host proteins indicate stroke in children with tuberculous meningitis. PLoS One, 2021, 16(4): e0250944.
31.	Misra UK, Kalita J, Maurya PK. Stroke in tuberculous meningitis. J Neurol Sci, 2011, 303(1-2): 22-30.
32.	乔凯, 尚丹鹤, 贾宝辉. 儿童结核性脑膜炎近期预后的影响因素分析. 中国实用神经疾病杂志, 2019, 22(9): 993-999.
33.	任斐, 李冬, 周倩倩, 等. 影响儿童结核性脑膜炎患者近期预后的相关因素分析. 中国防痨杂志, 2014, 36(11): 930-935.
34.	du Preez K, Jenkins HE, Donald PR, et al. Tuberculous meningitis in children: s forgotten public health emergency. Front Neurol, 2022, 13: 751133.
35.	van Well GT, Paes BF, Terwee CB, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics, 2009, 123(1): e1-e8.
36.	Abdella A, Deginet E, Weldegebreal F, et al. Tuberculous meningitis in children: treatment outcomes at discharge and its associated factors in Eastern Ethiopia: a five years retrospective study. Infect Drug Resist, 2022, 15: 2743-2751.
37.	Nuwagira E, Huppler Hullsiek K, Jjunju S, et al. Diagnostic and prognostic value of cerebrospinal fluid lactate and glucose in HIV-associated tuberculosis meningitis. Microbiol Spectr, 2022, 10(4): e0161822.
38.	Wang W, Gao J, Liu J, et al. Clinical efficacy of dexamethasone in the treatment of patients with tuberculous meningitis: a meta-analysis. Contrast Media Mol Imaging, 2022, 2022: 2180374.
39.	Inamdar P, Masavkar S, Shanbag P. Hyponatremia in children with tuberculous meningitis: a hospital-based cohort study. J Pediatr Neurosci, 2016, 11(3): 182-187.

1. 朱会. 88例儿童结核性脑膜炎临床特点、类赫氏反应及预后危险因素分析. 遵义: 遵义医科大学, 2020.
2. 姚雪华. 儿童结核性脑膜炎预后及相关危险因素分析. 中国实用神经疾病杂志, 2019, 22(9): 1006-1012.
3. 陈理雪, 舒敏. 儿童结核性脑膜炎与营养不良的关系及营养支持. 实用医院临床杂志, 2019, 16(3): 240-242.
4. Huynh J, Abo YN, du Preez K, et al. Tuberculous meningitis in children: reducing the burden of death and disability. Pathogens, 2021, 11(1): 38.
5. Chiang SS, Khan FA, Milstein MB, et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis, 2014, 14(10): 947-957.
6. Rahimi BA, Niazi N, Rahimi AF, et al. Treatment outcomes and risk factors of death in childhood tuberculous meningitis in Kandahar, Afghanistan: a prospective observational cohort study. Trans R Soc Trop Med Hyg, 2022, 116(12): 1181-1190.
7. Paganini H, Gonzalez F, Santander C, et al. Tuberculous meningitis in children: clinical features and outcome in 40 cases. Scand J Infect Dis, 2000, 32(1): 41-45.
8. Nataprawira HM, Gafar F, Risan NA, et al. Treatment outcomes of childhood tuberculous meningitis in a real-world retrospective cohort, Bandung, Indonesia. Emerg Infect Dis, 2022, 28(3): 660-671.
9. Israni AV, Dave DA, Mandal A, et al. Tubercular meningitis in children: clinical, pathological, and radiological profile and factors associated with mortality. J Neurosci Rural Pract, 2016, 7(3): 400-404.
10. Jadaun P, Patil R, Ramteke S, et al. A study to assess the clinico-radiological presentation and outcome predictors in cases of tubercular meningitis. Indian J Tuberc, 2021, 68(3): 384-388.
11. Kelekçi S, Karabel M, Karabel D, et al. Bacillus Calmette-Guérin is a preventive factor in mortality of childhood tuberculous meningitis. Int J Infect Dis, 2014, 21: 1-4.
12. Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis, 2010, 10(11): 803-812.
13. 李沪生, 黄凤, 高玉婷, 等. 术前不同糖化血红蛋白水平对成人心脏手术患者预后影响的Meta分析. 中国全科医学, 2022, 25(17): 2135-2144.
14. 邹丹. 儿童结核性脑膜炎临床特点及死亡危险因素分析. 重庆: 重庆医科大学, 2014.
15. 宋承平, 吴吉丽, 罗宏. 儿童结核性脑膜炎34例临床分析. 中国药物与临床, 2017, 17(5): 715-716.
16. 幸琳琳, 解元元, 朱朝敏. 卡介苗接种预防儿童结核性脑膜炎回顾研究. 中国实用儿科杂志, 2009, 24(6): 469-470, 473.
17. Topley JM, Bamber S, Coovadia HM, et al. Tuberculous meningitis and co-infection with HIV. Ann Trop Paediatr, 1998, 18(4): 261-266.
18. Seddon JA, Visser DH, Bartens M, et al. Impact of drug resistance on clinical outcome in children with tuberculous meningitis. Pediatr Infect Dis J, 2012, 31(7): 711-716.
19. Karande S, Gupta V, Kulkarni M, et al. Prognostic clinical variables in childhood tuberculous meningitis: an experience from Mumbai, India. Neurol India, 2005, 53(2): 191-195.
20. Bang ND, Caws M, Truc TT, et al. Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: a prospective descriptive study. BMC Infect Dis, 2016, 16(1): 573.
21. Salih R, van Toorn R, Seddon JA, et al. The impact of hyponatremia on the severity of childhood tuberculous meningitis. Front Neurol, 2022, 12: 703352.
22. Carranza C, Carreto-Binaghi LE, Guzmán-Beltrán S, et al. Sex-dependent differential expression of lipidic mediators associated with inflammation resolution in patients with pulmonary tuberculosis. Biomolecules, 2022, 12(4): 490.
23. Syggelou A, Spyridis N, Benetatou K, et al. BCG vaccine protection against TB infection among children older than 5 years in close contact with an infectious adult TB case. J Clin Med, 2020, 9(10): 3224.
24. Seddon JA, Wilkinson R, van Crevel R, et al. Knowledge gaps and research priorities in tuberculous meningitis. Wellcome Open Res, 2019, 4: 188.
25. Daniel BD, Grace GA, Natrajan M. Tuberculous meningitis in children: clinical management & outcome. Indian J Med Res, 2019, 150(2): 117-130.
26. Seid G, Alemu A, Dagne B, et al. Microbiological diagnosis and mortality of tuberculosis meningitis: systematic review and meta-analysis. PLoS One, 2023, 18(2): e0279203.
27. 杨妮, 苏茜, 肖月, 等. 2158例MTB/HIV双重感染患者治疗转归及影响因素分析. 中国防痨杂志, 2021, 43(3): 274-279.
28. 杨汝铃, 龙晓茹, 张祯祯, 等. 222例儿童结核性脑膜炎的临床特征及其预后影响因素分析. 中国防痨杂志, 2020, 42(10): 1053-1060.
29. Wang MS, Zhao M, Liu XJ. Risk factors for poor outcome in childhood tuberculous meningitis. Sci Rep, 2021, 11(1): 8654.
30. Manyelo CM, Chegou NN, Seddon JA, et al. Serum and cerebrospinal fluid host proteins indicate stroke in children with tuberculous meningitis. PLoS One, 2021, 16(4): e0250944.
31. Misra UK, Kalita J, Maurya PK. Stroke in tuberculous meningitis. J Neurol Sci, 2011, 303(1-2): 22-30.
32. 乔凯, 尚丹鹤, 贾宝辉. 儿童结核性脑膜炎近期预后的影响因素分析. 中国实用神经疾病杂志, 2019, 22(9): 993-999.
33. 任斐, 李冬, 周倩倩, 等. 影响儿童结核性脑膜炎患者近期预后的相关因素分析. 中国防痨杂志, 2014, 36(11): 930-935.
34. du Preez K, Jenkins HE, Donald PR, et al. Tuberculous meningitis in children: s forgotten public health emergency. Front Neurol, 2022, 13: 751133.
35. van Well GT, Paes BF, Terwee CB, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics, 2009, 123(1): e1-e8.
36. Abdella A, Deginet E, Weldegebreal F, et al. Tuberculous meningitis in children: treatment outcomes at discharge and its associated factors in Eastern Ethiopia: a five years retrospective study. Infect Drug Resist, 2022, 15: 2743-2751.
37. Nuwagira E, Huppler Hullsiek K, Jjunju S, et al. Diagnostic and prognostic value of cerebrospinal fluid lactate and glucose in HIV-associated tuberculosis meningitis. Microbiol Spectr, 2022, 10(4): e0161822.
38. Wang W, Gao J, Liu J, et al. Clinical efficacy of dexamethasone in the treatment of patients with tuberculous meningitis: a meta-analysis. Contrast Media Mol Imaging, 2022, 2022: 2180374.
39. Inamdar P, Masavkar S, Shanbag P. Hyponatremia in children with tuberculous meningitis: a hospital-based cohort study. J Pediatr Neurosci, 2016, 11(3): 182-187.

Chinese Journal of Evidence-Based Medicine

The risk factors for mortality in children with tuberculous meningitis: a meta-analysis

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