Abstract Details

Title Clinical Factors Associated with Poor Outcomes in Patients with Central Nervous System Tuberculosis Treated in San Francisco, CA from 2011 to 2021

Topic Infectious Disease

Presentation(s) S25 - Infectious Disease: Clinical Clues and Management (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Background CNS TB is one of the most severe forms of TB. Studies evaluating risk factors for mortality and disability due to CNS TB are lacking across low- and high-resource settings.

Objective

To identify risk factors associated with mortality and poor functional outcomes in patients with central nervous system tuberculosis (CNS TB) cared for in San Francisco, CA.

Design/Methods Search terms were used to identify medical records from patients with possible CNS TB at two medical centers in San Francisco, CA between January 1st, 2011, and November 1st, 2021. Data was extracted from a sample (n=75) of cases who met criteria for definite or suspected CNS TB warranting treatment with anti-tuberculous medications. Logistic regression models were performed to identify associations of demographic factors, comorbidities, and clinical signs/symptoms with mortality and functional outcomes.

Results Of 75 cases of CNS TB, most were men (60%), 18-64 years of age (67%), foreign-born (75%), and publicly insured (60%). Diabetes (28%) and hypertension (45%) were common comorbidities. The prevalence of HIV (9.8%) was 32 times higher than in the general California population. Many patients experienced long-term moderate to severe impairments in mobility (56%) and cognition (47%) and loss of independent function (50%). Increasing age (OR=1.04 per year, 95%CI:1.00-1.07), hypertension (OR=5.40, 95%CI:1.24-23.10), intubation (OR=9.14, 95%CI: 2.14-39.07), and altered mental status (OR=7.09, 95%CI: 1.61-31.30) were significantly associated with increased odds of mortality. Altered mental status at presentation (p<0.001) and hydrocephalus (p=0.040) were associated with a greater likelihood of long-term cognitive impairment.

Conclusions Mortality and functional impairment were common in patients with CNS TB cared for over the past decade in San Francisco. Older patients and those with hypertension had worse outcomes, as did patients presenting with altered mental status and hydrocephalus. Earlier CNS TB diagnosis and more effective treatment, including for patients with select risk factors, are needed to improve outcomes.

Authors/Disclosures
Felicia Chow, MD (Zuckerberg San Francisco General Hospital) PRESENTER	Dr. Chow has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Medicolegal consulting. The institution of Dr. Chow has received research support from NIH.
Carlos Hernandez Castillo	Mr. HERNANDEZ CASTILLO has nothing to disclose.
	No disclosure on file
	No disclosure on file