预测南突尼斯淋巴细胞性脑膜炎患者结核病的新评分系统

Houda Ben Ayed , Makram Koubaa , Sirine Chtourou , Khaoula Rekik , Fatma Hammami , Chakib Marrekchi , Jamel Damak , Mounir Ben Jemaa
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摘要

背景结核性脑膜炎(TBM)引起的死亡和不良结局在很大程度上受到治疗开始延迟的影响,而治疗开始延迟通常发生在淋巴细胞性脑膜炎(LM)中。本研究旨在提出一种易于使用的临床预测评分,可以准确诊断LM患者中的TBM。方法这是一项前瞻性队列研究,包括2008年至2022年在突尼斯南部传染病科住院的所有LM患者。结果在290例LM患者中,105例(36.2%)有TBM。经多因素分析,年龄≥60岁,农村出身,症状持续时间≥5天,有刺激感,一般情况恶化,住院时间≥10天,形态复杂,血白细胞计数<;4000/mm3、CSF/血糖比<;0.5、脑积水和蛛网膜炎是TBM的独立因素。将1至3分的个体诊断指数归因于这些因素,得出0至16分的总分。在截止值为7时,预测评分的受试者操作特征(ROC)面积为0.94,敏感性、特异性和诊断准确率分别为81%、91.4%和87.5%。
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A new scoring system to predict tuberculosis among South-Tunisian patients with lymphocytic meningitis

Background

Death and poor outcome due to Tuberculous meningitis (TBM) is greatly influenced by the delayed treatment initiation, which often occurs in lymphocytic meningitis (LM). This study aimed to propose an easy-to-use clinical prediction score that can accurately diagnose TBM among LM patients.

Methods

It was a prospective cohort study including all patients with LM hospitalized at the infectious diseases department in Southern Tunisia from 2008 to 2022 were included.

Results

Among 290 LM patients, 105 cases (36.2%) had TBM. By multivariate analysis, age ≥60 years, rural origin, symptom duration ≥5days, thrill, deteriorated general conditions, a hospital stay ≥ 10 days, complicated forms, blood white cells count <4000/mm3, CSF/blood glucose ratio<0.5, hydrocephalus and arachnoiditis were independent factors of TBM. Individual diagnosis indexes from 1 to 3 points were attributed to these factors to produce an overall score ranging from 0 to 16 points. At a cut-off of 7, the predictive score had a receiver operating characteristic (ROC) area of 0.94, a sensitivity, a specificity and a diagnosis accuracy of respectively 81%, 91.4%, and 87.5%.

Conclusions

This original study proposed a novel scoring system that can reliably identify patients with TBM at hospital admission and could be easily used in clinical practice.

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