Clinical Factors Associated with Poor Outcomes in Patients with Central Nervous System Tuberculosis Treated in San Francisco, CA from 2011 to 2021
CARLOS HERNANDEZ CASTILLO1, Janice Louie2, Laura Romo2, Felicia Chow3
1University of California, San Francisco, 2Tuberculosis Prevention and Control Program, San Francisco Department of Public Health, 3Zuckerberg San Francisco General Hospital
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.
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.
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.