The online version of this article (doi:10.1186/s12879-017-2309-9) contains supplementary material, which is available to authorized users.
Death under care is a major challenge for tuberculosis (TB) treatment programs. We derived and validated a simple score to predict mortality during tuberculosis treatment in high endemicity areas.
We used data for patients aged ≥15 years, diagnosed and treated for tuberculosis at the Yaounde Jamot Hospital between January 2012 and December 2013. Baseline characteristics associated with mortality were investigated using logistic regressions. A simple prognosis score (CABI) was constructed with regression coefficients for predictors in the final model. Internal validation used bootstrap resampling procedures. Models discrimination was assessed using c-statistics and calibration assessed via calibration plots and the Hosmer and Lemeshwow (H-L) statistics. The optimal score was based on the Youden’s index.
A total of 2250 patients (men 57.2%) with a mean age of 35.8 years were included; among whom 213 deaths (cumulative incidence 9.5%) were recorded. Clinical form of tuberculosis (C), age (A, years), adjusted body mass index (B, BMI, kg/m2) and status for HIV (Human immunodefiency virus) infection (I) were significant predictors in the final model (p < 0.0001) which was of the form Death risk = 1/(1 + e − (−1.3120 + 0.0474 ∗ age − 0.1866 ∗ BMI + 1.1637 (if smear negative TB) + 0.5418(if extra − pulmonary TB) + 1.3820(if HIV+))). The c-statistic was 0.812 in the derivation sample and 0.808 after correction for optimism. The calibration was good [H-Lχ2 = 6.44 (p = 0.60)]. The optimal absolute risk threshold was 4.8%, corresponding to a sensitivity of 81% and specificity of 67%.
The preliminary promising findings from this study require confirmation through independent external validation studies. If confirmed, the model derived could facilitate the stratification of TB patients for mortality risk and implementation of additional monitoring and management measures in vulnerable patients.
Additional file 1: Table S1. Point scoring for a death prediction score in tuberculosis patients. (DOCX 19 kb)12879_2017_2309_MOESM1_ESM.docx
Murray CJL, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:1005–70. CrossRefPubMedPubMedCentral
WHO | Global tuberculosis report 2014. World Health Organization. http://www.who.int/tb/publications/global_report/en/. Accessed 5 Mar 2015.
National Tuberculosis Control Program. Manual for health personnel. Yaounde: Ministry of public health of Cameroon; 2012.
World Health Organisation. Treatment of tuberculosis guidelines. 4th ed. Geneva: WHO; 2010.
Collett D. Modelling binary data. 2nd ed. New York: Chapman & Hall/CRC; 2003.
Hosmer D, Lemeshow S. Applied logistic regression. 2nd ed. New York: Willey; 2000. CrossRef
Van’t Hoog AH, Williamson J, Sewe M, Mboya P, Odeny LO, Agaya JA, Amolloh M, Borgdorff MW, et al. Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya. Int J Tuberc Lung Dis. 2012;16:1649–56. CrossRef
Low S, Ang LW, Cutter J, James L, Chee CBE, Wang YT, et al. Mortality among tuberculosis patients on treatment in Singapore. Int J Tuberc Lung Dis. 2009;13:328–34. PubMed
Kim HJ, Lee CH, Shin S, Lee JH, Kim YW, Chung HS, et al. The impact of nutritional deficit on mortality of in-patients with pulmonary tuberculosis. Int J Tuberc Lung Dis. 2010;14:79–85. PubMed
Lai YJ, Liu EY, Wang LM, Morano JP, Wang N, Khoshnood K, et al. Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China. Biomed Environ Sci. 2015;28:421–8. PubMed
- Development and validation of a prognostic score during tuberculosis treatment
Eric Walter Pefura-Yone
Adamou Dodo Balkissou
Hadja Koté Fatime-Abaicho
Patrick Thierry Enono-Edende
André Pascal Kengne
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II