Risk Factors for Poor Neurological Outcomes at Discharge in Tuberculous Meningitis: Disease Severity, Host Factors, and Drug Therapy

Introduction: This study investigated independent factors associated with neurological prognosis at discharge in patients with tuberculous meningitis (TBM) and evaluated the impact of intensified treatment regimens. Methods: A retrospective analysis was conducted in 518 TBM patients from two Chinese medical centers. LASSO and multivariable logistic regression were used to identify independent risk factors for poor neurological outcomes. A 1:1 PSM based on intensified treatment exposure was performed to assess its association with neurological outcomes, with an exploratory outcome-based matched comparison conducted for other prognostic factors. Results: Among 518 patients, 123 (23.75%) had poor neurological outcomes. The poor-prognosis group had higher proportions of MRC stage III (30.08% vs. 8.35%, p < 0.001), linezolid use (58.54% vs. 40.76%, |SMD| = 0.361), and fluoroquinolone use (87.8% vs. 75.19%, |SMD| = 0.386). Multivariable analysis identified decreased muscle strength, MRC stage II/III, albumin < 30 g/L, and hydrocephalus as independent risk factors for poor neurological outcomes. After treatment-exposure-based PSM, intensified treatment was not significantly associated with neurological outcomes, while an exploratory matched analysis suggested a potential association between diabetes mellitus and unfavorable neurological outcomes. Conclusion: Neurological prognosis in TBM is influenced by both disease severity and host baseline status. Intensified therapy was not significantly associated with neurological outcome at discharge after adjustment, highlighting the importance of individualized risk management.