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A Prediction Rule to Stratify Mortality Risk of Patients with Pulmonary Tuberculosis.

A Prediction Rule to Stratify Mortality Risk of Patients with Pulmonary Tuberculosis.
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Bastos HN, Osório NS, Castro AG, Ramos A, Carvalho T, Meira L, Araújo D, Almeida L, Boaventura R, Fragata P, Chaves C, Costa P, Portela M, Ferreira I, Magalhães SP, Rodrigues F, Sarmento-Castro R, Duarte R, Guimarães JT, Saraiva M,


Bastos HN, Osório NS, Castro AG, Ramos A, Carvalho T, Meira L, Araújo D, Almeida L, Boaventura R, Fragata P, Chaves C, Costa P, Portela M, Ferreira I, Magalhães SP, Rodrigues F, Sarmento-Castro R, Duarte R, Guimarães JT, Saraiva M, (click to view)

Bastos HN, Osório NS, Castro AG, Ramos A, Carvalho T, Meira L, Araújo D, Almeida L, Boaventura R, Fragata P, Chaves C, Costa P, Portela M, Ferreira I, Magalhães SP, Rodrigues F, Sarmento-Castro R, Duarte R, Guimarães JT, Saraiva M,

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PloS one 2016 9 1611(9) e0162797 doi 10.1371/journal.pone.0162797

Abstract

Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8-7.9), age ≥50 years (OR 2.9, 95% CI 1.7-4.8), bilateral lung involvement (OR 2.5, 95% CI 1.4-4.4), ≥1 significant comorbidity-HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease-(OR 2.3, 95% CI 1.3-3.8), and hemoglobin <12 g/dL (OR 1.8, 95% CI 1.1-3.1). A tuberculosis risk assessment tool (TReAT) was developed, stratifying patients with low (score ≤2), moderate (score 3-5) and high (score ≥6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment.

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