{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T02:03:16Z","timestamp":1761789796161},"reference-count":36,"publisher":"Scientific Scholar","license":[{"start":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T00:00:00Z","timestamp":1615766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ruralneuropractice.com"],"crossmark-restriction":true},"short-container-title":["JNRP"],"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:p>\n<jats:bold>Background<\/jats:bold>\u2003Cardiogenic brain abscess (CBA) is the commonest noncardiac cause of morbidity and mortality in cyanotic heart disease (CHD). The clinical diagnosis of a CBA is often delayed due to its nonspecific presentations and the scarce availability of computed tomography (CT) imaging in resource-restricted settings. We attempted to identify parameters that reliably point to the diagnosis of a CBA in patients with Tetralogy of Fallot (TOF).<\/jats:p>\n<jats:p>\n<jats:bold>Methods<\/jats:bold>\u2003From among 150 children with TOF treated at a tertiary care institute over a 15-year period from 2001 to 2016, 30 consecutive patients with CBAs and 85 age- and sex-matched controls without CBAs were included in this retrospective case\u2013control study. Demographic and clinical features, laboratory investigations, and baseline echocardiographic findings were analyzed for possible correlations with the presence of a CBA.<\/jats:p>\n<jats:p>\n<jats:bold>Statistical Analysis<\/jats:bold>\u2003Variables demonstrating significant bivariate correlations with the presence of a CBA were further analyzed using multivariate logistic regression (LR) analysis. Various LR models were tested for their predictive value, and the best model was then validated on a hold-out dataset of 25 patients.<\/jats:p>\n<jats:p>\n<jats:bold>Results<\/jats:bold>\u2003Among the 26 variables tested for bivariate associations with the presence of a CBA, some of the clinical, echocardiographic, and laboratory variables demonstrated significant correlations (<jats:italic>p<\/jats:italic> &lt; 0.05). LR analysis revealed elevated neutrophil\u2013lymphocyte ratio and erythrocyte sedimentation rate values and a lower age-adjusted resting heart rate percentile to be the strongest independent biomarkers of a CBA. The LR model was statistically significant, (\u03c7<jats:sup>2<\/jats:sup> = 23.72, <jats:italic>p =<\/jats:italic> &lt;0.001), and it fitted the data well. It explained 53% (Nagelkerke <jats:italic>R<\/jats:italic>\n<jats:italic>2<\/jats:italic>) of the variance in occurrence of a CBA, and correctly classified 83.93% of cases. The model demonstrated a good predictive value (area under the curve: 0.80) on validation analysis.<\/jats:p>\n<jats:p>\n<jats:bold>Conclusions<\/jats:bold>\u2003This study has identified simple clinical and laboratory parameters that can serve as reliable pointers of a CBA in patients with TOF. A scoring model\u2014the \u2018BA-TOF\u2019 score\u2014that predicts the occurrence of a CBA has been proposed. Patients with higher scores on the proposed model should be referred urgently for a CT confirmation of the diagnosis. Usage of such a diagnostic aid in resource-limited settings can optimize the pickup rates of a CBA and potentially improve outcomes.<\/jats:p>","DOI":"10.1055\/s-0041-1722819","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T08:31:56Z","timestamp":1615883516000},"page":"302-307","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical and Laboratory Markers of Brain Abscess in Tetralogy of Fallot (\u2018BA-TOF\u2019 Score): Results of a Case\u2013Control Study and Implications for Community Surveillance"],"prefix":"10.25259","volume":"12","author":[{"given":"Vidyasagar","family":"Kanneganti","sequence":"first","affiliation":[{"name":"Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumit","family":"Thakar","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saritha","family":"Aryan","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prayaag","family":"Kini","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dilip","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alangar S.","family":"Hegde","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2021,3,15]]},"reference":[{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-1","first-page":"190","article-title":"Brain abscess in cyanotic congenital heart disease","volume":"41","author":"Chakraborty","year":"1989","journal-title":"Indian Heart J"},{"issue":"11","key":"10.1055\/s-0041-1722819\/ref-2","first-page":"312","article-title":"Brain abscess and congenital heart disease","volume":"88","author":"Ghosh","year":"1990","journal-title":"J Indian Med Assoc"},{"issue":"9","key":"10.1055\/s-0041-1722819\/ref-3","doi-asserted-by":"crossref","first-page":"667","DOI":"10.2176\/nmc.32.667","article-title":"Risk factors for brain abscess in patients with congenital cyanotic heart disease","volume":"32","author":"Takeshita","year":"1992","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"2","key":"10.1055\/s-0041-1722819\/ref-4","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1161\/01.CIR.48.2.392","article-title":"Natural history of tetralogy of Fallot in infancy. Clinical classification and therapeutic implications","volume":"48","author":"Bonchek","year":"1973","journal-title":"Circulation"},{"issue":"12","key":"10.1055\/s-0041-1722819\/ref-5","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s13312-018-1445-7","article-title":"Congenital heart disease in India: a status report","volume":"55","author":"Saxena","year":"2018","journal-title":"Indian Pediatr"},{"issue":"2","key":"10.1055\/s-0041-1722819\/ref-6","doi-asserted-by":"crossref","first-page":"212","DOI":"10.4103\/aca.ACA_4_17","article-title":"Coagulopathies in cyanotic cardiac patients: an analysis with three point - of - care testing devices (thromboelastography, rotational thromboelastometry, and Sonoclot analyzer)","volume":"20","author":"Bhardwaj","year":"2017","journal-title":"Ann Card Anaesth"},{"issue":"1","key":"10.1055\/s-0041-1722819\/ref-7","first-page":"e1178","article-title":"Bilirubin acts as an endogenous regulator of inflammation by disrupting adhesion molecule-mediated leukocyte migration","volume":"3","author":"Vogel","year":"2016","journal-title":"Inflamm Cell Signal"},{"issue":"1","key":"10.1055\/s-0041-1722819\/ref-8","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1755-7682-5-2","article-title":"Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population","volume":"5","author":"Imtiaz","year":"2012","journal-title":"Int Arch Med"},{"key":"10.1055\/s-0041-1722819\/ref-9","first-page":"313","article-title":"Inflammatory index and treatment of brain abscess","volume":"74","author":"Oyama","year":"2012","journal-title":"Nagoya J Med Sci"},{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-10","doi-asserted-by":"crossref","first-page":"358","DOI":"10.3171\/jns.1987.67.3.0358","article-title":"C-reactive protein levels in the differential diagnosis of brain abscesses","volume":"67","author":"Hirschberg","year":"1987","journal-title":"J Neurosurg"},{"issue":"7","key":"10.1055\/s-0041-1722819\/ref-11","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1212\/WNL.7.7.480","article-title":"Erythrocyte sedimentation rate in patients with intracranial mass lesions","volume":"7","author":"Hass","year":"1957","journal-title":"Neurology"},{"issue":"1","key":"10.1055\/s-0041-1722819\/ref-12","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1053\/j.pcsu.2010.02.005","article-title":"The challenge of congenital heart disease worldwide: epidemiologic and demographic facts","volume":"13","author":"Bernier","year":"2010","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu"},{"issue":"4","key":"10.1055\/s-0041-1722819\/ref-13","doi-asserted-by":"crossref","first-page":"141","DOI":"10.5830\/CVJA-2013-028","article-title":"The global burden of congenital heart disease","volume":"24","author":"Hoffman","year":"2013","journal-title":"Cardiovasc J Afr"},{"key":"10.1055\/s-0041-1722819\/ref-14","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1017\/S1047951108002801","article-title":"The improvement of care for paediatric and congenital cardiac disease across the world: a challenge for the World Society for Pediatric and Congenital Heart Surgery","volume":"18","author":"Tchervenkov","year":"2008","journal-title":"Cardiol Young"},{"issue":"6","key":"10.1055\/s-0041-1722819\/ref-15","doi-asserted-by":"crossref","first-page":"E3","DOI":"10.3171\/FOC\/2008\/24\/6\/E3","article-title":"Management of brain abscess: an overview","volume":"24","author":"Moorthy","year":"2008","journal-title":"Neurosurg Focus"},{"issue":"7","key":"10.1055\/s-0041-1722819\/ref-16","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/BF00304791","article-title":"Management of brain abscess in children: review of 130 cases over a period of 21 years","volume":"8","author":"Tekk\u00f6k","year":"1992","journal-title":"Childs Nerv Syst"},{"issue":"6","key":"10.1055\/s-0041-1722819\/ref-17","doi-asserted-by":"crossref","first-page":"913","DOI":"10.3171\/jns.1983.58.6.0913","article-title":"Brain abscess in congenital cyanotic heart disease","volume":"58","author":"Kagawa","year":"1983","journal-title":"J Neurosurg"},{"key":"10.1055\/s-0041-1722819\/ref-18","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/BF01886672","article-title":"Brain abscess and congenital heart disease","volume":"33","author":"Bhatia","year":"1976","journal-title":"Acta Neurochir (Wien)"},{"issue":"1","key":"10.1055\/s-0041-1722819\/ref-19","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1186\/s13104-017-3071-1","article-title":"Lack of CT scanner in a rural emergency department increases inter-facility transfers: a pilot study","volume":"10","author":"Bergeron","year":"2017","journal-title":"BMC Res Notes"},{"key":"10.1055\/s-0041-1722819\/ref-20","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.jacr.2015.09.008","article-title":"The impact of hospital characteristics on the availability of radiology services at critical access hospitals","volume":"12","author":"Khaliq","year":"2015","journal-title":"J Am Coll Radiol"},{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-21","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/ajr.12125","article-title":"The impact of a rural scanner in overcoming urban versus rural disparities in the utilisation of computed tomography","volume":"23","author":"Nixon","year":"2015","journal-title":"Aust J Rural Health"},{"issue":"4","key":"10.1055\/s-0041-1722819\/ref-22","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1086\/515541","article-title":"Brain abscess","volume":"25","author":"Mathisen","year":"1997","journal-title":"Clin Infect Dis"},{"key":"10.1055\/s-0041-1722819\/ref-23","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.wneu.2017.07.144","article-title":"Forgotten? Not yet. Cardiogenic brain abscess in children: a case series-based review","volume":"107","author":"Udayakumaran","year":"2017","journal-title":"World Neurosurg"},{"key":"10.1055\/s-0041-1722819\/ref-24","first-page":"3285","author":"Loftus","year":"1996","unstructured":"Diagnosis and management of brain abscess. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. New York: McGraw-Hill"},{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-25","doi-asserted-by":"crossref","first-page":"E14","DOI":"10.1111\/j.1747-0803.2011.00586.x","article-title":"Headache and papilledema in an adult with cyanotic congenital heart disease: the importance of fundoscopic evaluation rather than phlebotomy","volume":"7","author":"Loomba","year":"2012","journal-title":"Congenit Heart Dis"},{"issue":"12","key":"10.1055\/s-0041-1722819\/ref-26","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1007\/s11606-007-0356-4","article-title":"Cyanotic congenital heart disease (CCHD) with symptomatic erythrocytosis","volume":"22","author":"Rose","year":"2007","journal-title":"J Gen Intern Med"},{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-27","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.amjcard.2007.08.047","article-title":"Prevalence of migraine headaches in patients with congenital heart disease","volume":"101","author":"Truong","year":"2008","journal-title":"Am J Cardiol"},{"key":"10.1055\/s-0041-1722819\/ref-28","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-020-04696-2","article-title":"Low threshold for intracranial imaging in fever of unknown origin associated with cyanotic heart disease in the pediatric population","author":"Rolle","year":"2020","journal-title":"Childs Nerv Syst"},{"issue":"2","key":"10.1055\/s-0041-1722819\/ref-29","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1602\/neurorx.1.2.182","article-title":"Biomarkers: potential uses and limitations","volume":"1","author":"Mayeux","year":"2004","journal-title":"NeuroRx"},{"key":"10.1055\/s-0041-1722819\/ref-30","first-page":"3","author":"Hulka","year":"1990","unstructured":"Overview of biological markers. In: Hulka BS, Griffith JD, Wilcosky TC, eds. Biological Markers in Epidemiology. New York: Oxford University Press"},{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-31","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1093\/carcin\/21.3.517","article-title":"Molecular epidemiology: recent advances and future directions","volume":"21","author":"Perera","year":"2000","journal-title":"Carcinogenesis"},{"issue":"1","key":"10.1055\/s-0041-1722819\/ref-32","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/0002-9149(74)90099-X","article-title":"Risk factors of brain abscess in patients with congenital heart disease","volume":"34","author":"Fischbein","year":"1974","journal-title":"Am J Cardiol"},{"key":"10.1055\/s-0041-1722819\/ref-33","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.3389\/fneur.2019.01032","article-title":"Clinical significance of baseline neutrophil-to-lymphocyte ratio in patients with ischemic stroke or hemorrhagic stroke: an updated meta-analysis","volume":"10","author":"Song","year":"2019","journal-title":"Front Neurol"},{"issue":"1","key":"10.1055\/s-0041-1722819\/ref-34","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/QCO.0000000000000334","article-title":"Epidemiology, diagnosis, and treatment of brain abscesses","volume":"30","author":"Brouwer","year":"2017","journal-title":"Curr Opin Infect Dis"},{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-35","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/S0735-1097(96)00196-9","article-title":"Cerebrovascular events in adult patients with cyanotic congenital heart disease","volume":"28","author":"Ammash","year":"1996","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"10.1055\/s-0041-1722819\/ref-36","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1055\/s-0040-1709260","article-title":"Perioperative complications and clinical out-comes in patients with congenital cyanotic heart disease undergoing surgery for brain abscess","volume":"11","author":"Vimala","year":"2020","journal-title":"J Neurosci Rural Pract"}],"container-title":["Journal of Neurosciences in Rural Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ruralneuropractice.com\/clinical-and-laboratory-markers-of-brain-abscess-in-tetralogy-of-fallot-ba-tof-score-results-of-a-case-control-study-and-implications-for-community-surveillance\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ruralneuropractice.com\/clinical-and-laboratory-markers-of-brain-abscess-in-tetralogy-of-fallot-ba-tof-score-results-of-a-case-control-study-and-implications-for-community-surveillance\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,5]],"date-time":"2023-08-05T04:42:10Z","timestamp":1691210530000},"score":1,"resource":{"primary":{"URL":"https:\/\/ruralneuropractice.com\/clinical-and-laboratory-markers-of-brain-abscess-in-tetralogy-of-fallot-ba-tof-score-results-of-a-case-control-study-and-implications-for-community-surveillance\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,15]]},"references-count":36,"alternative-id":["10.1055\/s-0041-1722819"],"URL":"https:\/\/doi.org\/10.1055\/s-0041-1722819","relation":{},"ISSN":["0976-3147"],"issn-type":[{"value":"0976-3147","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,15]]},"article-number":"302"}}