Ocular Inflammatory Disease as a Predictor for In-Hospital Mortality in Patients Hospitalized with Disseminated Tuberculosis.

Abstract

AimTo ascertain whether the presence of ocular inflammatory disease is a predictor for death in patients hospitalized with disseminated tuberculosis.MethodsThis is an IRB-approved retrospective study of patients admitted with a diagnosis of disseminated tuberculosis within a seven-year period (2002–2009). The following data was collected from each record: age, sex, details of previous surgeries or therapy, the findings of anterior segment examination, the findings of dilated indirect ophthalmoscopy, systemic findings, investigations done, treatment rendered, and final status (died or discharged).ResultsA total of 57 patients (29 males (50.8%), 28 females (49.2%) with ages ranging from 14 to 78 years (mean 41.7 years) were identified. Common presentations included fever, sepsis or neurological complaints such as headache or convulsions. Significant medical histories included acquired immune deficiency syndrome (AIDS) (n= 4), renal allograft transplantation (n=3), chronic renal failure on hemodialysis (n=3) and type 2 diabetes mellitus (n=6).Of these, 35 patients (61.4%) had ocular tuberculosis. These included 19 males (54.2%) and 16 females (46.8%) with ages ranging from 16 to 78 years (mean 43.3 years). Current medical conditions included AIDS, renal allograft transplantation and subsequent immunosuppressive therapy, chronic renal failure on hemodialysis, and type 2 diabetes mellitus. Forty-seven of the 70 eyes (67.1%) had evidence of ocular tuberculosis. Specific presentations included 42 eyes (89.1%) with choroidal tubercles and five eyes (10.9%) with chorioretinitis. Two patients (2.8%) had disc edema. Of these 35 patients, eight (22.8%) patients died whereas 27 (77.2%) were discharged.The remaining 22 patients (38.6%) had no ocular tuberculosis. These included 10 males (45.5%) and 12 females (54.5%) with ages ranging from 14 to 78 years (mean 39.1 years). Significant medical histories included type 2 diabetes mellitus. Of these 44 eyes, four eyes (9.09%) had non-proliferative diabetic retinopathy, two eyes (4.5%) had optic atrophy and two eyes (4.5%) had disc edema. One patient (4.5%) patient of this group of 22 died, whereas 21 (95.5%) were discharged.We analyzed the differences in survival with Fisher’s Exact test between patients who died in the hospital and those who were discharged (statistically insignificant at p value of 0.05). Outcomes of patients with two, three, or four risk factors were analyzed using unconditional logistic regression but all tests failed to reach statistical significance.ConclusionsThe presence of ocular inflammation was independent of final outcome, either singly or as part of a risk factor cluster.