Abstract
BackgroundDeath 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.MethodsWe 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.ResultsA 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%.ConclusionsThe 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.
Highlights
Death under care is a major challenge for tuberculosis (TB) treatment programs
Data available Of the 3369 patients treated for TB during the study period, 384 (11.4%) had missing data on weight and/or status for Human immunodefiency virus (HIV), the outcome was unknown in 859 (25.5%) patients including 567 who were lost to follow-up, 244 who were transferred to other centres and 48 failed on treatment; they were all excluded
Predictors retained in our final model were essentially those previously known to be associated with mortality risk in tuberculosis [10,11,12,13,14,15,16,17,18,19,20,21]
Summary
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. Pefura-Yone et al BMC Infectious Diseases (2017) 17:251 tuberculosis [4]. Their cohort did not include patients with HIV infection, and did not account for other clinical forms of tuberculosis (PTB− and extrapulmonary TB). The aim of the present study was to develop and validate a simple score for predicting the risk of death during follow-up in patients starting TB treatment in areas of high endemicity for TB, and high prevalence of HIV infection
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