Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.
C1 [Erdem, Hakan; Oncul, Oral] GATA Haydarpasa Training Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Erdem, Hakan] GATA Haydarpasa AH, Enfeksiyon Hastaliklari Servisi, Istanbul, Turkey.
[Ozturk-Engin, Derya; Inan, Asuman; Ceran, Nurgul; Senbayrak, Seniha] Haydarpasa Numune Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Tireli, Hulya] Haydarpasa Numune Training & Res Hosp, Dept Neurol, Istanbul, Turkey.
[Kilicoglu, Gamze] Haydarpasa Numune Training & Res Hosp, Dept Radiol, Istanbul, Turkey.
[Defres, Sylviane] Univ Liverpool, Inst Infect & Global Hlth, Liverpool L69 3BX, Merseyside, England.
[Defres, Sylviane] Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Trop Infect Dis Unit, Liverpool, Merseyside, England.
[Gulsun, Serda] Diyarbakir Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Diyarbakir, Turkey.
[Sengoz, Gonul; Pehlivanoglu, Filiz] Haseki Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Crisan, Alexandru] Victor Babes Univ Med & Pharm, Dept Infect Dis, Timisoara, Romania.
[Johansen, Isik Somuncu] Odense Univ Hosp, Dept Infect Dis Q, DK-5000 Odense, Denmark.
[Nechifor, Mihai] Gr T Popa Univ Med & Pharm, Dept Pharmacol, Iasi, Romania.
[Al-Mahdawi, Akram] Baghdad Teaching Hosp, Dept Neurol, Baghdad, Iraq.
[Civljak, Rok] Univ Zagreb, Sch Med, Dr Fran Mihaljev Univ Hosp Infect Dis, Dept Infect Dis, Zagreb 41000, Croatia.
[Ozguler, Muge; Akbulut, Ayhan] Firat Univ, Sch Med, Dept Infect Dis & Clin Microbiol, TR-23169 Elazig, Turkey.
[Savic, Branislava] Univ Belgrade, Fac Med, Inst Microbiol & Immunol, Natl Reference Lab TB, Belgrade, Serbia.
[Cacopardo, Bruno] Univ Catania, Dept Clin & Mol Biomed, Infect Dis Sect, Catania, Italy.
[Inal, Ayse Seza] Cukurova Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Adana, Turkey.
[Namiduru, Mustafa] Gaziantep Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Gaziantep, Turkey.
[Dayan, Saim; Tekin, Recep; Deveci, Ozcan] Dicle Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Diyarbakir, Turkey.
[Kayabas, Uner] Inonu Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Malatya, Turkey.
[Parlak, Emine; Parlak, Mehmet] Ataturk Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Erzurum, Turkey.
[Khalifa, Ahmad] Damascus Hosp, Dept Neurol, Damascus, Syria.
[Kursun, Ebru] Baskent Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Adana, Turkey.
[Sipahi, Oguz Resat] Ege Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.
[Yemisen, Mucahit] Istanbul Univ, Cerrahpasa Med Sch, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Bitirgen, Mehmet; Kandemir, Bahar] Necmettin Erbakan Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Konya, Turkey.
[Popovic, Natasa] Clin Ctr Serbia, Clin Infect & Trop Dis, Belgrade, Serbia.
[Luca, Catalina] Gr T Popa Univ Med & Pharm, Dept Infect Dis, Iasi, Romania.
[Stahl, Jean Paul] Univ Grenoble 1, Dept Infect Dis, Grenoble, France.
[Stahl, Jean Paul] Univ Hosp Grenoble, Grenoble, France.
[Simeon, Soline] Univ Hosp Pontchaillou, Dept Infect & Trop Dis, Rennes, France.
[Ulu-Kilic, Aysegul; Alabay, Selma] Erciyes Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Kayseri, Turkey.
[Yasar, Kadriye] Bakirkoy Dr Sadi Konuk Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Yilmaz, Gulden] Ankara Univ, Sch Med, Dept Infect Dis & Clin Microbiol, TR-06100 Ankara, Turkey.
[Yilmaz, Emel] Uludag Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Bursa, Turkey.
[Beovic, Bojana] Univ Med Ctr, Dept Infect Dis, Ljubljana, Slovenia.
[Catroux, Melanie] Univ Poitiers Hosp, Dept Infect Dis, Poitiers, France.
[Lakatos, Botond] St Laszlo Hosp, Dept Infect Dis, Budapest, Hungary.
[Sunbul, Mustafa] Ondokuz Mayis Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Samsun, Turkey.
[Sahin-Horasan, Elif] Mersin Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Kose, Sukran] Tepecik Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.
[Shehata, Ghaydaa] Assiut Univ Hosp, Dept Neurol & Psychiat, Assiut, Egypt.
[Andre, Katell] Dax Hosp, Dept Infect Dis, Dax, France.
[Dragovac, Gorana] Univ Novi Sad, Fac Med, IPH Vojvodina, Dept Prevent & Control Dis, Novi Sad 21000, Serbia.
[Gul, Hanefi Cem; Karakas, Ahmet] Gulhane Mil Med Acad, Dept Infect Dis & Clin Microbiol, Ankara, Turkey.
[Chadapaud, Stephane] Marie Jose Treffot Hosp, Dept Infect Dis, Hyeres, France.
[Hansmann, Yves] Univ Hosp, Dept Infect Dis, Strasbourg, France.
[Harxhi, Arjan] Univ Hosp Ctr Tirana, Infect Dis Serv, Tirana, Albania.
[Kirova, Valerija] Univ Clin Infect Dis & Febrile Condit, Skopje, Macedonia.
[Masse-Chabredier, Isabelle] Aurillac Hosp, Dept Infect Dis, Aurillac, France.
[Oncu, Serkan] Adnan Menderes Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Aydin, Turkey.
[Sener, Alper] Onsekiz Mart Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Canakkale, Turkey.
[Elaldi, Nazif] Cumhuriyet Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Sivas, Turkey.
[Ozkaya, Hacer Deniz] Karsiyaka State Hosp, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.
[Karabay, Oguz] Sakarya Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Sakarya, Turkey.
[Agalar, Canan] Fatih Sultan Mehmet Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.
[Vahaboglu, Haluk] Medeniyet Univ, Goztepe Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey.