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Journal of Neurology

, Volume 262, Issue 4, pp 890–898 | Cite as

Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study

  • Hakan ErdemEmail author
  • Derya Ozturk-Engin
  • Hulya Tireli
  • Gamze Kilicoglu
  • Sylviane Defres
  • Serda Gulsun
  • Gonul Sengoz
  • Alexandru Crisan
  • Isik Somuncu Johansen
  • Asuman Inan
  • Mihai Nechifor
  • Akram Al-Mahdawi
  • Rok Civljak
  • Muge Ozguler
  • Branislava Savic
  • Nurgul Ceran
  • Bruno Cacopardo
  • Ayse Seza Inal
  • Mustafa Namiduru
  • Saim Dayan
  • Uner Kayabas
  • Emine Parlak
  • Ahmad Khalifa
  • Ebru Kursun
  • Oguz Resat Sipahi
  • Mucahit Yemisen
  • Ayhan Akbulut
  • Mehmet Bitirgen
  • Natasa Popovic
  • Bahar Kandemir
  • Catalina Luca
  • Mehmet Parlak
  • Jean Paul Stahl
  • Filiz Pehlivanoglu
  • Soline Simeon
  • Aysegul Ulu-Kilic
  • Kadriye Yasar
  • Gulden Yilmaz
  • Emel Yilmaz
  • Bojana Beovic
  • Melanie Catroux
  • Botond Lakatos
  • Mustafa Sunbul
  • Oral Oncul
  • Selma Alabay
  • Elif Sahin-Horasan
  • Sukran Kose
  • Ghaydaa Shehata
  • Katell Andre
  • Gorana Dragovac
  • Hanefi Cem Gul
  • Ahmet Karakas
  • Stéphane Chadapaud
  • Yves Hansmann
  • Arjan Harxhi
  • Valerija Kirova
  • Isabelle Masse-Chabredier
  • Serkan Oncu
  • Alper Sener
  • Recep Tekin
  • Nazif Elaldi
  • Ozcan Deveci
  • Hacer Deniz Ozkaya
  • Oguz Karabay
  • Seniha Senbayrak
  • Canan Agalar
  • Haluk Vahaboglu
Original Communication

Abstract

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.

Keywords

Tuberculosis Meningitis Death Outcome Sequelae 

Notes

Acknowledgments

We would like to thank Patrick Royston, an honorary professor of statistics in the Department of Statistical Science at University College of London, for his guidance in statistics, and for the valuable contributions he made in reviewing the statistical method and results of the study.

Conflicts of interest

We have no competing interests to declare.

Ethical standard

The Institutional Review Board of Fatih Sultan Mehmet Training and Research Hospital in Istanbul approved the study protocol.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Hakan Erdem
    • 1
    • 57
    Email author
  • Derya Ozturk-Engin
    • 2
  • Hulya Tireli
    • 3
  • Gamze Kilicoglu
    • 4
  • Sylviane Defres
    • 5
    • 6
  • Serda Gulsun
    • 7
  • Gonul Sengoz
    • 8
  • Alexandru Crisan
    • 9
  • Isik Somuncu Johansen
    • 10
  • Asuman Inan
    • 2
  • Mihai Nechifor
    • 11
  • Akram Al-Mahdawi
    • 12
  • Rok Civljak
    • 13
  • Muge Ozguler
    • 14
  • Branislava Savic
    • 15
  • Nurgul Ceran
    • 2
  • Bruno Cacopardo
    • 16
  • Ayse Seza Inal
    • 17
  • Mustafa Namiduru
    • 18
  • Saim Dayan
    • 19
  • Uner Kayabas
    • 20
  • Emine Parlak
    • 21
  • Ahmad Khalifa
    • 22
  • Ebru Kursun
    • 23
  • Oguz Resat Sipahi
    • 24
  • Mucahit Yemisen
    • 25
  • Ayhan Akbulut
    • 14
  • Mehmet Bitirgen
    • 26
  • Natasa Popovic
    • 27
  • Bahar Kandemir
    • 26
  • Catalina Luca
    • 28
  • Mehmet Parlak
    • 21
  • Jean Paul Stahl
    • 29
  • Filiz Pehlivanoglu
    • 8
  • Soline Simeon
    • 30
  • Aysegul Ulu-Kilic
    • 31
  • Kadriye Yasar
    • 32
  • Gulden Yilmaz
    • 33
  • Emel Yilmaz
    • 34
  • Bojana Beovic
    • 35
  • Melanie Catroux
    • 36
  • Botond Lakatos
    • 37
  • Mustafa Sunbul
    • 38
  • Oral Oncul
    • 1
  • Selma Alabay
    • 31
  • Elif Sahin-Horasan
    • 39
  • Sukran Kose
    • 40
  • Ghaydaa Shehata
    • 41
  • Katell Andre
    • 42
  • Gorana Dragovac
    • 43
  • Hanefi Cem Gul
    • 44
  • Ahmet Karakas
    • 44
  • Stéphane Chadapaud
    • 45
  • Yves Hansmann
    • 46
  • Arjan Harxhi
    • 47
  • Valerija Kirova
    • 48
  • Isabelle Masse-Chabredier
    • 49
  • Serkan Oncu
    • 50
  • Alper Sener
    • 51
  • Recep Tekin
    • 19
  • Nazif Elaldi
    • 52
  • Ozcan Deveci
    • 19
  • Hacer Deniz Ozkaya
    • 53
  • Oguz Karabay
    • 54
  • Seniha Senbayrak
    • 2
  • Canan Agalar
    • 55
  • Haluk Vahaboglu
    • 56
  1. 1.Department of Infectious Diseases and Clinical MicrobiologyGATA Haydarpasa Training HospitalIstanbulTurkey
  2. 2.Department of Infectious Diseases and Clinical MicrobiologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  3. 3.Department of NeurologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  4. 4.Department of RadiologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  5. 5.Institute of Infection & Global HealthUniversity of LiverpoolLiverpoolUK
  6. 6.Tropical Infections Diseases Unit in Royal Liverpool and Broadgreen University Hospitals NHS TrustLiverpoolUK
  7. 7.Department of Infectious Diseases and Clinical MicrobiologyDiyarbakir Training and Research HospitalDiyarbakirTurkey
  8. 8.Department of Infectious Diseases and Clinical MicrobiologyHaseki Training and Research HospitalIstanbulTurkey
  9. 9.Department of Infectious DiseasesVictor Babes University of Medicine and PharmacyTimisoaraRomania
  10. 10.Department of Infectious Diseases QOdense University HospitalOdenseDenmark
  11. 11.Department of PharmacologyGr. T. Popa University of Medicine and PharmacyIasiRomania
  12. 12.Department of NeurologyBaghdad Teaching HospitalBaghdadIraq
  13. 13.Department of Infectious DiseasesDr. Fran Mihaljevic University Hospital for Infectious Diseases, University of Zagreb School of MedicineZagrebCroatia
  14. 14.Department of Infectious Diseases and Clinical MicrobiologyFirat University School of MedicineElazigTurkey
  15. 15.Institute of Microbiology and Immunology, National Reference Laboratory for Tuberculosis, Faculty of MedicineUniversity of BelgradeBelgradeSerbia
  16. 16.Section of Infectious Diseases, Department of Clinical and Molecular BiomedicineUniversity of CataniaCataniaItaly
  17. 17.Department of Infectious Diseases and Clinical MicrobiologyCukurova University School of MedicineAdanaTurkey
  18. 18.Department of Infectious Diseases and Clinical MicrobiologyGaziantep University School of MedicineGaziantepTurkey
  19. 19.Department of Infectious Diseases and Clinical MicrobiologyDicle University School of MedicineDiyarbakirTurkey
  20. 20.Department of Infectious Diseases and Clinical MicrobiologyInonu University School of MedicineMalatyaTurkey
  21. 21.Department of Infectious Diseases and Clinical MicrobiologyAtaturk University School of MedicineErzurumTurkey
  22. 22.Department of NeurologyDamascus HospitalDamascusSyria
  23. 23.Department of Infectious Diseases and Clinical MicrobiologyBaskent University School of MedicineAdanaTurkey
  24. 24.Department of Infectious Diseases and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
  25. 25.Department of Infectious Diseases and Clinical MicrobiologyIstanbul University Cerrahpasa School of MedicineIstanbulTurkey
  26. 26.Department of Infectious Diseases and Clinical MicrobiologyNecmettin Erbakan University School of MedicineKonyaTurkey
  27. 27.Clinic for Infectious and Tropical DiseasesClinical Centre of SerbiaBelgradeSerbia
  28. 28.Department of Infectious DiseasesGr. T. Popa University of Medicine and PharmacyIasiRomania
  29. 29.Department of Infectious DiseasesJoseph Fourier University and University Hospital of GrenobleGrenobleFrance
  30. 30.Department of Infectious and Tropical DiseasesUniversity Hospital of PontchaillouRennesFrance
  31. 31.Department of Infectious Diseases and Clinical MicrobiologyErciyes University School of MedicineKayseriTurkey
  32. 32.Department of Infectious Diseases and Clinical MicrobiologyBakırkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
  33. 33.Department of Infectious Diseases and Clinical MicrobiologyAnkara University School of MedicineAnkaraTurkey
  34. 34.Department of Infectious Diseases and Clinical MicrobiologyUludag University School of MedicineBursaTurkey
  35. 35.Department of Infectious DiseasesUniversity Medical CentreLjubljanaSlovenia
  36. 36.Department of Infectious DiseasesPoitiers University HospitalPoitiersFrance
  37. 37.Department of Infectious DiseasesSaint Laszlo HospitalBudapestHungary
  38. 38.Department of Infectious Diseases and Clinical MicrobiologyOndokuz Mayis University School of MedicineSamsunTurkey
  39. 39.Department of Infectious Diseases and Clinical MicrobiologyMersin University School of MedicineIstanbulTurkey
  40. 40.Department of Infectious Diseases and Clinical MicrobiologyTepecik Training and Research HospitalIzmirTurkey
  41. 41.Department of Neurology and PsychiatryAssiut University HospitalAssiutEgypt
  42. 42.Department of Infectious DiseasesDax HospitalDaxFrance
  43. 43.Department of Prevention and Control of Diseases, Medical Faculty, IPH of VojvodinaUniversity of Novi SadNovi SadSerbia
  44. 44.Department of Infectious Diseases and Clinical MicrobiologyGulhane Medical AcademyAnkaraTurkey
  45. 45.Department of Infectious DiseasesMarie José Treffot HospitalHyeresFrance
  46. 46.Department of Infectious DiseasesUniversity HospitalStrasbourgFrance
  47. 47.Service of Infectious DiseaseUniversity Hospital Center of TiranaTiranaAlbania
  48. 48.University Clinic for Infectious Diseases and Febrile ConditionsSkopjeMacedonia
  49. 49.Department of Infectious DiseasesAurillac HospitalAurillacFrance
  50. 50.Department of Infectious Diseases and Clinical MicrobiologyAdnan Menderes University School of MedicineAydinTurkey
  51. 51.Department of Infectious Diseases and Clinical MicrobiologyOnsekiz Mart University School of MedicineCanakkaleTurkey
  52. 52.Department of Infectious Diseases and Clinical MicrobiologyCumhuriyet University School of MedicineSivasTurkey
  53. 53.Department of Infectious Diseases and Clinical MicrobiologyKarsiyaka State HospitalIzmirTurkey
  54. 54.Department of Infectious Diseases and Clinical MicrobiologySakarya University School of MedicineSakaryaTurkey
  55. 55.Department of Infectious Diseases and Clinical MicrobiologyFatih Sultan Mehmet Training and Research HospitalIstanbulTurkey
  56. 56.Department of Infectious Diseases and Clinical Microbiology, Goztepe Training and Research HospitalMedeniyet UniversityIstanbulTurkey
  57. 57.Enfeksiyon Hastalıkları ServisiGATA Haydarpasa AHIstanbulTurkey

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