Determinants of Early postoperative Mortality in patients with High Grade Glioma in Nairobi, Kenya

Abstract

Objective: To determine factors influencing early postoperative mortality(within 3 months) in patients with high grade glioma. Methodology: A case series, with a retrospective and prospective arm carried out between January 2018 and June 2019. Subject selection: Patients with a diagnosis of high grade glioma attending the neurosurgery clinic at Kenyatta National hospital. For the retrospective 6-month arm, patients had their records traced in the surgical operations book and files in the records department. They were then contacted and on the next visit recruited into the study. For the prospective arm, we recruited patients sequentially as they presented in the clinic until the end of the study period. All patients received routine standard of care. Results: Three patients (17.6%) gave reasons for delay symptoms not being serious enough followed by two patients (11.8%) each for whom primary physician was the cause of the delay and also lack of finances. Other reasons given by one patient (5.9%) each were they thought it was another ailment, sought alternative care and there was lack of family support. Clinically, 10 patients (58.8%) had a Glasgow coma scale of 15, with 2(11.8%) having a GCS of 14 and 1(5.9%) each having a GCS of 13 and 9. The Mean Karnofsky Score was 78.7% (range 30%-100%). On imaging, 5 patients (29.4%) were found in the parietal lobe, 4 patients (23.5%) had tumors in the frontal lobe, 3 patients(17.6%) had tumours in the temporal lobe and 2 patients(11.8%) had tumors in the occipital lobe. All tumors were supratentorial. Nine patients (52.9%) had tumors were in the left hemisphere with 5 patients (29.4%) had tumours in the right hemisphere. The mean tumor size was 118.6 cm3 +/- 94.2cm3 (range 18cm3 to 300cm3) . Ten patients(58.8%) had well defined margins compared with 4 patients(23.5%) who had ill-defined margins. Surrounding edema was present in 17 patients(76.5%) compared to only 1 patient(5.9%) with no edema. At three months, 7 patients (41.2%) were alive and 8 patients (47.1%) confirmed dead. Two patients (11.8%) were lost to followup. Conclusion: On chi square test, the independent factors predicting survival at 3 months included IDH-1 mutated status, duration of symptoms greater than 3 months at presentation, tumor in all other lobes except patietal lobe left sided tumors and presence of edema on imaging.