Author(s):
Bastos, Hélder Novais ; 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
Date: 2016
Persistent ID: https://hdl.handle.net/1822/44877
Origin: RepositóriUM - Universidade do Minho
Description
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.
