Tesis

Karakteristik Klinis Dan Analisis Kesintasan Meningitis Tuberkulosis Dewasa Berdasarkan Status HIV di RSUPN Dr. Cipto Mangunkusumo = Clinical Characteristics and Survival Analysis of Adult Tuberculous Meningitis with and without HIV infection at Cipto Mangunkusumo Hospital.

Latar Belakang: Meningitis tuberkulosis (TBM) memiliki angka kematian yang tinggi khususnya pada HIV positif. Penelitian ini bertujuan untuk mengetahui karakteristik klinis dan prediktor kesintasan perawatan dan 6 bulan TBM berdasarkan status HIV. Metode: Kohort retrospektif subjek TBM Indonesian Brain Infection Study (April 2019September 2021). Prediktor kesintasan perawatan dianalisis dengan regresi logistik. Probabilitas kesintasan 6 bulan dan prediktornya dinilai menggunakan kurva Kaplan-Meier dan regresi Cox. Hasil: 133 subjek TBM dianalisis (HIV positif 39,8%, TBM definite 31,6%). HIV positif memiliki temuan TBM definite lebih rendah, peningkatan sel dan protein cairan serebrospinal (CSS) yang lebih rendah, penurunan rasio glukosa CSS:serum yang lebih rendah, dan TB milier yang lebih tinggi. Kesintasan masa perawatan secara umum adalah 73,7% (HIV positif 67,9%; HIV negatif 77,5%, p=0,2), dengan prediktor TBM probable dan TBM derajat 3. Probabilitas kesintasan 6 bulan adalah 57,9% (HIV positif 54,7%; HIV negatif 60%, p=0,4), dengan prediktor waktu inisiasi obat antituberkulosis (OAT) dan TBM derajat 3. Status HIV tidak berperan pada kesintasan masa perawatan dan 6 bulan. Kesimpulan: Kelompok HIV positif memiliki gambaran inflamasi CSS yang lebih rendah namun dengan kesintasan yang cenderung lebih rendah. TBM stadium lanjut berperan pada kesintasan jangka pendek dan panjang, sementara penundaan inisiasi OAT berhubungan dengan kesintasan jangka panjang.
Kata kunci: meningitis tuberkulosis; analisis kesintasan; prediktor; prognosis


Background: Tuberculous meningitis (TBM) has a high mortality rate, especially in HIV positive. This study aims to define the clinical characteristics as well as to analyze the inhospital and 6 month-survival of TBM, stratified by HIV status. Methods: Cohort retrospective study of TBM using Indonesian Brain Infection Study data, (April 2019-September 2021). Logistic regression was used to determine the predictors of inhospital survival. Six-months probability survival was analysed using Kaplan-Meier curves and Cox regression. Results: A total of 133 subjects were analyzed (HIV positive 39.8%, definite TBM 31.6%). HIV positive group had significantly less TBM definite, lower cerebrospinal fluids (CSF) cells and protein increases, smaller decrease in CSF:serum glucose ratio, and more miliary TB. Overall inhospital survival was 73.7% (HIV positive 67.9%; HIV negative 77.5%, p=0.2), with predictors of TBM probable and TBM grade 3. Six-month probability survival was 57.9% (HIV positive 54.7%; HIV negative 60%, p=0,4), with predictors of TB drug initiation timing and TBM grade 3. HIV status was not related to inhospital and 6-month mortality. Conclusions: Despite less inflammatory profile, HIV positive group had lower survival. Advanced TBM had lower inhospital and 6-month survival, while delayed TB drug initiation was more related to the 6-month survival.
Keywords: Tuberculous meningitis; survival analysis; predictors; prognosis