{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:16:41Z","timestamp":1767849401170,"version":"3.49.0"},"reference-count":45,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>No accurate and rapid diagnostic test exists for tuberculous meningitis (TBM), leading to delayed diagnosis. We leveraged data from multiple studies to improve the predictive performance of diagnostic models across different populations, settings, and subgroups to develop a new predictive tool for TBM diagnosis. We conducted a systematic review to analyze eligible datasets with individual-level participant data (IPD). We imputed missing data and explored three approaches: stepwise logistic regression, classification and regression tree (CART), and random forest regression. We evaluated performance using calibration plots and C-statistics via internal\u2013external cross-validation. We included 3,761 individual participants from 14 studies and nine countries. A total of 1,240 (33%) participants had \u201cdefinite\u201d (30%) or \u201cprobable\u201d (3%) TBM by case definition. Important predictive variables included cerebrospinal fluid (CSF) glucose, blood glucose, CSF white cell count, CSF differential, cryptococcal antigen, HIV status, and fever presence. Internal validation showed that performance varied considerably between IPD datasets with C-statistic values between 0.60 and 0.89. In external validation, CART performed the worst (C = 0.82), and logistic regression and random forest had the same accuracy (C = 0.91). We developed a mobile app for TBM clinical prediction that accounted for heterogeneity and improved diagnostic performance (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/tbmcalc.github.io\/tbmcalc\" xlink:type=\"simple\">https:\/\/tbmcalc.github.io\/tbmcalc<\/jats:ext-link>). Further external validation is needed.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0789","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T19:22:42Z","timestamp":1721848962000},"page":"546-553","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Prediction Model for Tuberculous Meningitis: An Individual Participant Data Meta-Analysis"],"prefix":"10.4269","volume":"111","author":[{"given":"Anna M.","family":"Stadelman-Behar","sequence":"first","affiliation":[{"name":"School of Public Health, University of Minnesota, Minneapolis, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicki","family":"Tiffin","sequence":"additional","affiliation":[{"name":"South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa;"},{"name":"Wellcome CIDRI\u2013Africa, University of Cape Town, Cape Town, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayne","family":"Ellis","sequence":"additional","affiliation":[{"name":"MRC\/UVRI-LSHTM Uganda Research Unit, Entebbe, Uganda;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona V.","family":"Creswell","sequence":"additional","affiliation":[{"name":"MRC\/UVRI-LSHTM Uganda Research Unit, Entebbe, Uganda;"},{"name":"Global Health and Infection, Brighton and Sussex Medical School, East Sussex, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Ssebambulidde","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin","family":"Nuwagira","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Richards","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Helen Joseph Hospital, University of Witwatersrand, Johannesburg, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittoria","family":"Lutje","sequence":"additional","affiliation":[{"name":"Cochrane Infectious Diseases Group, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana","family":"Hristea","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy Carol Davila, Bucharest, Romania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raluca Elena","family":"Jipa","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy Carol Davila, Bucharest, Romania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 E.","family":"Vidal","sequence":"additional","affiliation":[{"name":"Departmento de Neurologia, Instituto de Infectologia Em\u00edlio, S\u00e3o Paulo, Brazil;"},{"name":"Divis\u00e3o de Cl\u00ednica de Mol\u00e9stias Infecciosas e Parasit\u00e1rias, Hospital das Cl\u0131nicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil;"},{"name":"Laborat\u00f3rio de Investiga\u00e7\u00e3o M\u00e9dica, Unidade 49, Hospital das Cl\u00ednicas, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renata G. S.","family":"Azevedo","sequence":"additional","affiliation":[{"name":"Departmento de Infectologia, Instituto de Infectologia Em\u00edlio, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00e9rgio","family":"Monteiro de Almeida","sequence":"additional","affiliation":[{"name":"Hospital de Clinicas, Universidade Federal do Paran\u00e1, Curitiba, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gislene Bot\u00e3o","family":"Kussen","sequence":"additional","affiliation":[{"name":"Hospital de Clinicas, Universidade Federal do Paran\u00e1, Curitiba, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keite","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Hospital de Clinicas, Universidade Federal do Paran\u00e1, Curitiba, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe Augusto Souza","family":"Gualberto","sequence":"additional","affiliation":[{"name":"Center for Reference and Training in STD\/AIDS CRT DST\/AIDS, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatiana","family":"Metcalf","sequence":"additional","affiliation":[{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"Northern Pacific Fogarty Global Health Fellowship Program, National Institutes of Health, University of Washington, Seattle, Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Dorothee","family":"Heemskerk","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centre, Amsterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarek","family":"Dendane","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abidi","family":"Khalid","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amine","family":"Ali Zeggwagh","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Bateman","sequence":"additional","affiliation":[{"name":"Neurology Division, Department of Medicine Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;"},{"name":"Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"},{"name":"UMIT TIROL\u2014University for Health Sciences and Technology, Hall I.T., Tirol, Austria;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ursula","family":"Rochau","sequence":"additional","affiliation":[{"name":"UMIT TIROL\u2014University for Health Sciences and Technology, Hall I.T., Tirol, Austria;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjan","family":"van Laarhoven","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinout","family":"van Crevel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and 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Tropical Medicine, Ho Chi Minh City, Vietnam;"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan C.","family":"Bahr","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David B.","family":"Meya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda;"},{"name":"Department of Medicine, Faculty of Health Sciences, Makerere University, Kampala, Uganda;"},{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R.","family":"Boulware","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom H.","family":"Boyles","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom;"},{"name":"Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, Gauteng, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"PLOS Glob Public Health","first-page":"e0000069","article-title":"The global burden of tuberculous meningitis in adults: A modelling study","volume":"1","author":"Dodd","year":"2021"},{"key":"b2","series-title":"Nat Rev 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Lung Dis","first-page":"276","article-title":"Appropriate use of the Xpert (R) MTB\/RIF assay in suspected tuberculous meningitis","volume":"19","author":"Boyles","year":"2015"},{"key":"b7","series-title":"BMJ","first-page":"i3140","article-title":"External validation of clinical prediction models using big datasets from e-health records or IPD meta-analysis: Opportunities and challenges","volume":"353","author":"Riley","year":"2016"},{"key":"b8","series-title":"BMJ","first-page":"i6460","article-title":"A guide to systematic review and meta-analysis of prediction model performance","volume":"356","author":"Debray","year":"2017"},{"key":"b9","series-title":"BMC Med Res Methodol","first-page":"3","article-title":"Developing and validating risk prediction models in an individual participant data meta-analysis","volume":"14","author":"Ahmed","year":"2014"},{"key":"b10","series-title":"Stat Med","first-page":"3158","article-title":"A framework for developing, implementing, and evaluating clinical prediction models in an individual participant data meta-analysis","volume":"32","author":"Debray","year":"2013"},{"key":"b11","series-title":"Stat Med","first-page":"1841","article-title":"Imputation of systematically missing predictors in an individual participant data meta-analysis: A generalized approach using MICE","volume":"34","author":"Jolani","year":"2015"},{"key":"b12","series-title":"BMJ","first-page":"c221","article-title":"Meta-analysis of individual participant data: Rationale, conduct, and reporting","volume":"340","author":"Riley","year":"2010"},{"key":"b13","series-title":"JAMA","first-page":"1657","article-title":"Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data: The PRISMA-IPD statement","volume":"313","author":"Stewart","year":"2015"},{"key":"b14","series-title":"Wellcome Open Res","first-page":"19","article-title":"The diagnosis of tuberculous meningitis in adults and adolescents: Protocol for a systematic review and individual patient data meta-analysis to inform a multivariable prediction model","volume":"4","author":"Boyles","year":"2019"},{"key":"b15","series-title":"Global Tuberculosis Report 2019","year":"2019"},{"key":"b16","series-title":"Lancet Infect Dis","first-page":"803","article-title":"Tuberculous meningitis: A uniform case definition for use in clinical research","volume":"10","author":"Marais","year":"2010"},{"key":"b17","series-title":"Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating","author":"Steyerberg","year":"2009"},{"key":"b18","series-title":"Mon Weather Rev","first-page":"1","article-title":"Verification of forecasts expressed in terms of probability","volume":"78","author":"Brier","year":"1950"},{"key":"b19","series-title":"Ann Intern Med","first-page":"735","article-title":"Transparent reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD)","volume":"162","author":"Collins","year":"2015"},{"key":"b20","series-title":"J Neurol Sci","first-page":"253","article-title":"A predictive score followed by nucleic acid amplification for adult tuberculous meningitis diagnosis in southern Brazil","volume":"379","author":"Anselmo","year":"2017"},{"key":"b21","series-title":"Int J Tuberc Lung Dis","first-page":"1139","article-title":"Performance of nested RT-PCR on CSF for tuberculous meningitis diagnosis in HIV-infected patients","volume":"21","author":"Gualberto","year":"2017"},{"key":"b22","series-title":"Int J Tuberc Lung Dis","first-page":"706","article-title":"Xpert MTB\/RIF((R)) assay for the diagnosis of HIV-related tuberculous meningitis in Sao Paulo, Brazil","volume":"22","author":"Azevedo","year":"2018"},{"key":"b23","series-title":"Clin Chem Lab Med","first-page":"556","article-title":"Validation of Mycobacterium tuberculosis real-time polymerase chain reaction for diagnosis of tuberculous meningitis using cerebrospinal fluid samples: A pilot study","volume":"57","author":"de Almeida","year":"2019"},{"key":"b24","series-title":"J Clin Microbiol","first-page":"226","article-title":"Evaluation of GeneXpert MTB\/RIF for diagnosis of tuberculous meningitis","volume":"52","author":"Nhu","year":"2014"},{"key":"b25","series-title":"Lancet Infect Dis","first-page":"299","article-title":"Xpert MTB\/RIF Ultra versus Xpert MTB\/RIF for the diagnosis of tuberculous meningitis: A prospective, randomised, diagnostic accuracy study","volume":"20","author":"Donovan","year":"2020"},{"key":"b26","series-title":"PLoS One","first-page":"e38982","article-title":"Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis","volume":"7","author":"Botha","year":"2012"},{"key":"b27","series-title":"Pediatr Infect Dis J","first-page":"906","article-title":"Causes of pediatric meningitis in Botswana: Results from a 16-year national meningitis audit","volume":"38","author":"Mitchell","year":"2019"},{"key":"b28","series-title":"J Infect Dis","first-page":"1029","article-title":"Clinical parameters, routine inflammatory markers, and LTA4H genotype as predictors of mortality among 608 patients with tuberculous meningitis in Indonesia","volume":"215","author":"van Laarhoven","year":"2017"},{"key":"b29","series-title":"Int J Infect Dis","first-page":"e461","article-title":"A simple diagnostic aid for tuberculous meningitis in adults in Morocco by use of clinical and laboratory features","volume":"17","author":"Dendane","year":"2013"},{"key":"b30","series-title":"PLoS One","first-page":"e0198695","article-title":"Evaluation of the GeneXpert MTB\/RIF in patients with presumptive tuberculous meningitis","volume":"13","author":"Metcalf","year":"2018"},{"key":"b31","series-title":"Ann Indian Acad Neurol","first-page":"363","article-title":"Rapid clinical score for the diagnosis of tuberculous meningitis: A retrospective cohort study","volume":"20","author":"Jipa","year":"2017"},{"key":"b32","series-title":"Med Princ Pract","first-page":"151","article-title":"Thwaites\u2019 diagnostic scoring and the prediction of tuberculous meningitis","volume":"14","author":"Sunbul","year":"2005"},{"key":"b33","series-title":"Clin Neurol Neurosurg","first-page":"639","article-title":"Validation of diagnostic algorithm to differentiate between tuberculous meningitis and acute bacterial meningitis","volume":"114","author":"Vibha","year":"2012"},{"key":"b34","series-title":"Jpn J Infect Dis","first-page":"428","article-title":"Validation of Thwaites\u2019 diagnostic scoring system for the differential diagnosis of tuberculous meningitis and bacterial meningitis","volume":"67","author":"Zhang","year":"2014"},{"key":"b35","series-title":"J Neurol Sci","first-page":"112","article-title":"Validation of Thwaites Index for diagnosing tuberculous meningitis in a Colombian 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meta-analysis","volume":"7","author":"Stadelman","year":"2020"},{"key":"b40","series-title":"N Engl J Med","first-page":"1166","article-title":"Antiretroviral therapy after cryptococcal meningitis. 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