Little is known about the morbidity outcomes of Central Nervous system (CNS) infections. However, there is economic burden associated with disability from these infections. The characteristics and outcome of these patients are largely unknown in Singapore. Hence, we aim to describe the prognosis and factors associated with poor outcome in these patients.
Methods: Patients with suspected CNS infections were recruited prospectively from five tertiary hospitals and one national center from August 2013 to March 2016. Besides collecting demographics, clinical and microbiological data from routine clinical practice, patients were followed up till 6 month using Modified Rankin Scale (mRS) which was categorized into good outcome (0-2) and poor outcome (3-5).
Results: In total, 155 patients with median age of 49 years (Range: 18-88) were recruited. Etiologies of these patients were bacterial infections (44,28.4%), viral infections (20,12.9%), tuberculosis (17,11%), fungal infections (3,1.9%), parasitic infections (3,1.9%), autoimmune (7,4.5%) and unknown cases (61,39.4%). 66 patients completed 6 month follow-up, of which 55 (83.3%) had good outcome and 11(16.7%) had poor outcome. Univariate logistic regression analysis (LRA) showed that factors associated with poor outcome include presence of headache on admission [p = 0.03; OR = 0.20, 95% Confidence Interval (CI) 0.05-0.83], presence of focal weakness on admission[p = 0.027; OR = 4.9, 95% CI 1.20-19.92], lower Glasgow Coma Scale (GCS) on enrolment [p = 0.00; OR = 0.59, 95% CI 0.44-0.79], lower hemoglobin level on enrolment [p = 0.03; OR = 0.68, 95% CI 0.48- 0.96], Intensive care unit stay [p = 0.00; OR = 12.00, 95% CI 2.78-51.78] and longer duration of hospitalization [p = 0.01; OR = 1.05, 95% CI 1.01-1.09]. In multivariate LRA, we found that patients with co-morbidity [p = 0.04; OR = 9.33, 95% CI 1.13-77.10] and lower GCS on examination [p = 0.00; OR = 0.53, 95% (CI) 0.37-0.77] were significantly associated with poor outcome. There was no related death due to CNS infections during follow up.
Conclusion: Our study shows that the mortality of these patients was low and most of them achieved a good outcome at 6-month. Presence of co-morbidity and longer duration of hospitalization were strongly associated with poor outcome.