A predictive score for early in-patient tuberculosis mortality: A case-control study

Joseph Baruch Baluku , Priscilla Sheilla Apolot , Brenda Namanda , Sharon Namiiro , Shamim Katusabe , Diana Karungi , Reagan Nkonge , Mary Madalen Angut , Jasper Nidoi , Robinah Nalwanga , Charles Mondo , Emmanuel Seremba , Charles Kabugo
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Abstract

Introduction

In-hospital mortality rates for tuberculosis (TB) patients are high within the first seven days of admission. This study sought to identify predictors of early inpatient mortality and assess the performance of a predictive score for early mortality in a Ugandan tertiary hospital.

Materials and methods

A case-control study was conducted at Kiruddu National Referral Hospital in Kampala, Uganda. Cases included patients admitted with TB who died within seven days of admission, while controls survived beyond this period. Logistic regression was utilized to identify early mortality predictors. The performance of an adapted predictive score (PROS score) was evaluated, assigning scores based on the following criteria: Pulse rate >100 beats/min (1 point), Respiratory rate >20 breaths/min (2 points), Oxygen saturation <92 % (4 points), and Systolic blood pressure <90 mmHg (2 points).

Results

Of 602 hospitalized TB patients, 187 (31.0 %) died during admission. Among these, 78 (41.7 %) died within seven days. Wasting (adjusted odds ratio [aOR] = 5.76, 95 % confidence interval [CI] 2.12–15.63, p = 0.001) and respiratory rate >20 breaths/min (aOR = 2.89, 95 % CI 1.19–7.00, p = 0.019) predicted early mortality. PROS score of ≥1 demonstrated a sensitivity of 87.8 % and negative predictive value of 90.0 %. The ultimate TB treatment success rate of all hospitalized patients (n = 599) was 47.4 % with 275 (45.9 %) dying during TB treatment.

Conclusion

Early and long term mortality rates among hospitalized TB patients are high. Wasting and tachypnea predict early inpatient mortality. The PROS score could be useful in ruling out low-risk patients in low-resource settings.
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早期肺结核住院病人死亡率预测评分:病例对照研究
引言 结核病(TB)患者在入院头七天内的院内死亡率很高。这项研究旨在确定早期住院病人死亡率的预测因素,并评估乌干达一家三级医院早期死亡率预测评分的性能。材料与方法 在乌干达坎帕拉的基鲁杜国家转诊医院进行了一项病例对照研究。病例包括入院后七天内死亡的肺结核患者,而对照组患者在入院七天后仍存活。采用逻辑回归法确定早期死亡率预测因素。评估了经调整的预测评分(PROS 评分)的性能,评分标准如下:结果 在 602 名住院肺结核患者中,187 人(31.0%)在入院期间死亡。其中 78 人(41.7%)在七天内死亡。消瘦(调整赔率 [aOR] = 5.76,95 % 置信区间 [CI] 2.12-15.63,p = 0.001)和呼吸频率为 20 次/分(aOR = 2.89,95 % CI 1.19-7.00,p = 0.019)预示着早期死亡。PROS 评分≥1 的灵敏度为 87.8%,阴性预测值为 90.0%。所有住院患者(599 人)的最终结核病治疗成功率为 47.4%,其中 275 人(45.9%)在结核病治疗期间死亡。虚脱和呼吸急促可预测住院病人的早期死亡率。PROS 评分有助于排除低资源环境中的低风险患者。
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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
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