A prediction rule to stratify mortality risk of patients with pulmonary tuberculosis

• Main Author: Bastos, Hélder Novais
• Publication Date: 2016
• Other Authors: Osório, Nuno S., Castro, António G., Ramos, Angélica, Carvalho, Teresa, Meira, Leonor, Araújo, David, Almeida, Leonor, Boaventura, Rita, Fragata, Patrícia, Chaves, Catarina, Costa, Patrício Soares, Portela, Miguel, Ferreira, Ivo Ricardo Silva, Magalhães, Sara Pinto, Rodrigues, Fernando José dos Santos, Castro, Rui Manuel Rosário Sarmento, Duarte, Raquel, Guimarães, João Tiago, Saraiva, Margarida
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://hdl.handle.net/1822/44877
• topic: Ciências Médicas::Medicina Básica; Science & Technology

Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8-7.9), age >= 50 years (OR 2.9, 95% CI 1.7-4.8), bilateral lung involvement (OR 2.5, 95% CI 1.44.4), >= 1 significant comorbidity-HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease-(OR 2.3, 95% CI 1.3-3.8), and hemoglobin < 12 g/dL (OR 1.8, 95% CI 1.1-3.1). A tuberculosis risk assessment tool (TReAT) was developed, stratifying patients with low (score <= 2), moderate (score 3-5) and high (score >= 6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment.