Predictors of Mortality in CNS Tuberculosis: Clinical and Radiological Parameters

Abstract Background: Central nervous system tuberculosis (CNS-TB) is a rare but highly lethal form of tuberculosis with variable clinical and radiological presentations. This study aimed to identify clinical, laboratory, and neuroimaging parameters associated with mortality in CNS-TB. Methods: In this retrospective study, 15 patients diagnosed with CNS-TB between 2010 and 2023 were divided into survivors (n = 6) and non-survivors (n = 9). Demographic, clinical, cerebrospinal fluid (CSF), and magnetic resonance imaging (MRI) data were analyzed. Statistical comparisons and effect size analyses (Cohen’s d, h) were performed to assess clinical significance. Results: The mortality rate was 60%. Non-survivors were significantly older (57.8 ± 22.8 vs. 29.2 ± 6.9 years; P = 0.029, d = 1.56) and had higher serum AST levels (28.9 ± 6.4 vs. 15.0 ± 2.9 U/L; P = 0.007, d = 2.14). CSF leukocyte count was also significantly elevated in non-survivors (P = 0.041, d = 0.95). Cerebral ischemia was present only in non-survivors (56% vs. 0%; P = 0.04, h = 0.98). PCR positivity in non-CSF samples (0% vs. 78%) was significantly associated with mortality (P = 0.007). Other parameters showing moderate to large effect sizes included focal neurological deficits, ventriculitis, and increased CSF opening pressure. Conclusion: Advanced age, elevated AST levels, increased CSF leukocyte count, cerebral ischemia, and extraparenchymal PCR positivity emerged as major predictors of mortality in CNS-TB. These factors may aid early risk stratification and treatment planning. Larger prospective studies are warranted to validate these findings.