Development and validation of a prognostic score to predict tuberculosis mortality

Abstract

ObjectiveTo develop and validate a simple prognostic scoring system to predict the mortality risk during treatment in tuberculosis patients. MethodsUsing data from the CDC's Tuberculosis Genotyping Information Management System of TB patients in Texas reported from 01/2010 to 12/2016, age ≥ 15 years and having an outcome as “completed” or “died”, we developed and validated a prognostic mortality scoring system-based logistic regression beta-coefficients. ResultsThe developmental and validation cohorts consisted of 3378 and 3377 patients, respectively. The score used 9 demographic and clinical characteristics, which are usually available at the patient's initial visits to a healthcare facility. Prognostic scores were categorized into three groups that predicted mortality: low-risk (<15 points), medium-risk (15–18 points), and high-risk (>18 points). The model had excellent discrimination and calibration with an area under the receiver operating characteristic curve of 0.82 and 0.80, and a non-significant Hosmer–Lemeshow test P = 0.514 and P = 0.613 in the developmental and validation cohorts, respectively. ConclusionOur validated TB prognostic scoring system, which used demographic and clinical characteristics available at the patient's initial visits, can be a practical tool for health care providers to identify TB patients with high mortality risk so that appropriate treatment, medical supports and follow-up resources could be appropriately allocated.