TY - JOUR
T1 - Predictors of unfavourable outcome in adults with suspected central nervous system infections
T2 - a prospective cohort study
AU - I.-PACE Study Group
AU - Ter Horst, Liora
AU - van Zeggeren, Ingeborg E
AU - Olie, Sabine E
AU - van de Beek, Diederik
AU - Brouwer, Matthijs C
N1 - Funding Information: Supported by grants from the European Research Council (ERC Consolidator grant 101001237 to MB), and the Netherlands Organization for Health Research and Development (Vici grant number 918.19.627 to DvdB; Vidi grant number 917.17.308 to MB). Dr. Jan Meerwaldt Foundation (travel grant to LtH); Remmert Adriaan Laan Foundation (travel grant to LtH); Amsterdam University Fund (travel grant to LtH), and the Royal Netherlands Academy of Arts & Sciences (KNAW Van Leersum Grant to LtH). Publisher Copyright: © 2023, The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Suspected central nervous system (CNS) infections may pose a diagnostic challenge, and often concern severely ill patients. We aim to identify predictors of unfavourable outcome to prioritize diagnostics and treatment improvements. Unfavourable outcome was assessed on the Glasgow Outcome Scale at hospital discharge, defined by a score of 1 to 4. Of the 1152 episodes with suspected CNS infection, from two Dutch prospective cohorts, the median age was 54 (IQR 37-67), and 563 episodes (49%) occurred in women. The final diagnoses were categorized as CNS infection (N = 358 episodes, 31%), CNS inflammatory disease (N = 113, 10%), non-infectious non-inflammatory neurological disorder (N = 388, 34%), non-neurological infection (N = 252, 22%), and other systemic disorder (N = 41, 4%). Unfavourable outcome occurred in 412 of 1152 (36%), and 99 died (9%). Predictors for unfavourable outcomes included advanced age, absence of headache, tachycardia, altered mental state, focal cerebral deficits, cranial nerve palsies, low thrombocytes, high CSF protein, and the final diagnosis of CNS inflammatory disease (odds ratio 4.5 [95% confidence interval 1.5-12.6]). Episodes suspected of having a CNS infection face high risk of experiencing unfavourable outcome, stressing the urgent need for rapid and accurate diagnostics. Amongst the suspected CNS infection group, those diagnosed with CNS inflammatory disease have the highest risk.
AB - Suspected central nervous system (CNS) infections may pose a diagnostic challenge, and often concern severely ill patients. We aim to identify predictors of unfavourable outcome to prioritize diagnostics and treatment improvements. Unfavourable outcome was assessed on the Glasgow Outcome Scale at hospital discharge, defined by a score of 1 to 4. Of the 1152 episodes with suspected CNS infection, from two Dutch prospective cohorts, the median age was 54 (IQR 37-67), and 563 episodes (49%) occurred in women. The final diagnoses were categorized as CNS infection (N = 358 episodes, 31%), CNS inflammatory disease (N = 113, 10%), non-infectious non-inflammatory neurological disorder (N = 388, 34%), non-neurological infection (N = 252, 22%), and other systemic disorder (N = 41, 4%). Unfavourable outcome occurred in 412 of 1152 (36%), and 99 died (9%). Predictors for unfavourable outcomes included advanced age, absence of headache, tachycardia, altered mental state, focal cerebral deficits, cranial nerve palsies, low thrombocytes, high CSF protein, and the final diagnosis of CNS inflammatory disease (odds ratio 4.5 [95% confidence interval 1.5-12.6]). Episodes suspected of having a CNS infection face high risk of experiencing unfavourable outcome, stressing the urgent need for rapid and accurate diagnostics. Amongst the suspected CNS infection group, those diagnosed with CNS inflammatory disease have the highest risk.
UR - http://www.scopus.com/inward/record.url?scp=85178384648&partnerID=8YFLogxK
U2 - https://doi.org/10.1038/s41598-023-48472-z
DO - https://doi.org/10.1038/s41598-023-48472-z
M3 - Article
C2 - 38040800
SN - 2045-2322
VL - 13
SP - 21250
JO - Scientific reports
JF - Scientific reports
IS - 1
M1 - 21250
ER -