Clinical outcomes of different treatments and risk factors in patients with otogenic brain abscess, a real-world evidence-based retrospective study

Abstract

Background

Otogenic Brain Abscess (OBA) is a life-threatening complication secondary to otitis media, but its appropriate management remains controversial.

Objectives

To understand the demographic characteristics, management, and variables that affect the outcomes of patients with OBA based on our experiences over 11 years.

Material and methods

Clinical data were collected for 41 patients. Prognostic factors associated with mortality were assessed, and clinical outcomes compared among groups receiving different treatments.

Results

Among the 41 patients, 19.6% did not undergo surgery, 39.0% were treated with two-stage surgery (otological surgery and neurosurgery) and 41.4% were treated with single-stage surgery (otological surgery or neurosurgery). Overall mortality rate was 32.5%, and mortality was significantly higher in patients with invasion of the petrous apex (odds ratio [OR]: 7.81, 95% confidence interval [95% CI]: 1.26–48.36), and lower in those with appropriate surgical management (single otological surgery, OR: 0.07, 95% CI: 0–0.97; single neurosurgery, OR: 0.13, 95% CI: 0.02–1.0; two-stage surgery, OR: 0.08, 95% CI: 0.01–0.64) or a higher Glasgow Coma Scale (GCS) score at admission (OR: 0.64, 95% CI: 0.44–0.93).

Conclusions and significance

Data on invasiveness and pre-surgery GCS greatly aid in predicting the prognosis of OBA patients. Early evaluation will facilitate decision-making by physicians treating OBA patients.

Chinese abstract

背景：耳源性脑脓肿（OBA）是继发于中耳炎的危及生命的并发症, 但其适当的治疗仍存在争议。

目的：根据我们11年的经验, 了解影响OBA患者结果的 人口统计学特征、治疗和变量。

材料与方法：收集41例患者的临床资料。评估与死亡率相关的预后因素, 并比较不同治疗组之间的临床结局。

结果：41例患者中未手术的占19.6％, 接受两期治疗的占39.0％（耳科手术和神经外科手术）, 41.4％的患者接受了单期手术（耳科手术或神经外科）。总死亡率为32.5％, 岩骨尖浸润患者中死亡率显著更高（优势比[OR]：7.81, 95％置信区间

[95％CI]：1.26-48.36）, 而接受适当外科手术治疗的患者中死亡率较低（单耳科手术, OR：0.07, 95％CI：0-0.97；单神经外科手术, OR：0.13, 95％CI：0.02-1.0 ;两期手术, OR：0.08, 95％CI：0.01–0.64）或更高的格拉斯哥昏迷量表（GCS）评分（OR：0.64, 95％CI：0.44-0.93）。

结论和意义：侵袭性和术前GCS数据对预测OBA患者的预后有很大帮助。早期评估将有助于医师治疗OBA患者的决策。

Keywords:

• Otogenic brain abscess
• clinical outcome
• different treatment
• risk factor

Acknowledgments

All the authors have contributed significantly, and are in an agreement with the content of the manuscript.

Disclosure statement

The authors declare that they have no conflicts of interest.

Additional information

Funding

This work was supported by The Central Universities in China (No. 2012017yjsy118); Key Research and Development Support Programs of Chengdu Science and Technology Bureau (No. 2018YFYF00123SN); Key Research and Development Support Programs of Chengdu Science and Technology Bureau (No. 2019YF0500461SN); 1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (No. 2019HXFH003); The Fundamental Research Funds for the Central Universities (No. 20ZDYF3010); The Fundamental Research Funds for the Central Universities (No. 2019HXBH079); The Scientific and Technological Projects of Sichuan Province (No. 20ZDYF0266); The Scientific and Technological Projects of Sichuan Province (No. 20GJHZ0193); The Science and Technology Projects of Sichuan Health and Health Commission (No. 20PJYY1597); China Postdoctoral Science Foundation (No. 2020M673250); The Foundation of National Clinical Research Center for Geriatrics (No. Z20201013).