Procjena terapijskih mogućnosti u bolesnika s apscesom mozga [The estimation of therapeutical possibilities in patients with brain abscess]

Background: The aim of the study was to define influence of different surgical methods and patients’ characteristics on the outcome using propensity score model. Methods: Demographic characteristics, microbiology, clinical presentation and treatment outcome were analyzed for surgically treated adult patients with brain abscess over a fourteen-year period. Propensity score model for standard craniotomy was calculated for each patient. The outcome was favourable if Glasgow Outcome Score (GOS) was 4 or 5 on the day of hospital discharge. Logistic regression analysis was performed to show which factors may influence the outcome in patients with brain abscess. Results: We analyzed 91 adult surgically treated patients, from which 53 had standard craniotomy and 38 stereotactic aspiration of brain abscess. Focal neurological deficit was the most common symptom present in 60 (65.9%) patients on admission. Sixty seven patients (73.6%) had a favourable outcome (GOS 4 and 5) and seven patients (7.7%) died during treatment. The choice of surgery did not influence the outcome (OR 1.181, 95% CI 0.349-3.995), neither did time from diagnosis to surgery (OR 0.998, 95% CI 0.981-1.015). Propensity toward standard craniotomy procedure had not influence outcome in brain abscess patients (OR 1.181, 95%CI 0.349-3.995) Worse outcome was independently associated with Glasgow Coma Score on admission (OR 0.787, CI 0.656-0.944). Conclusions: The choice of neurosurgical procedure does not influence the outcome in patients with brain abscess. Patients with brain abscess who have lower GCS on admission have worse outcome.