Risk factors for early mortality in patients with pulmonary tuberculosis admitted to the emergency room

Pulmonology

卷:27

B. Raghu¹  D. Tayal²  Y. Jain³  R. Singla⁴  G.B. Migliori⁴  A. Chakraborty⁴  A. Gupta⁴  J.A. Caminero⁴  P. Sethi⁵ 

[1] Corresponding author at: Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India.;

[2] MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease, Paris 75006, France;

[3] Department of Biochemistry, National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India;

[4] Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, 110030, India;

[5] Pneumology Department, Hospital General de Gran Canaria “Dr. Negrin”, Las Palmas de Gran Canaria, 35010, Spain;

关键词: Pulmonary tuberculosis;    Risk factors;    Mortality;    Prediction score;    Intensive care;    Pulmonary rehabilitation;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background and objectives: Mortality of patients with pulmonary tuberculosis (TB) admitted to emergency departments is high. This study was aimed at analysing the risk factors associated with early mortality and designing a risk score based on simple parameters. Methods: This prospective case-control study enrolled patients admitted to the emergency department of a referral TB hospital. Clinical, radiological, biochemical and microbiological risk factors associated with death were compared among patients dying within one week from admission (cases) and those surviving (controls). Results: Forty-nine of 250 patients (19.6%) experienced early mortality. Multiple logistic regression analysis showed that oxygen saturation (SaO2) ≤90%, severe malnutrition, tachypnoea, tachycardia, hypotension, advanced disease at chest radiography, severe anaemia, hyponatremia, hypoproteinemia and hypercapnia were independently and significantly associated with early mortality. A clinical scoring system was further designed to stratify the risk of death by selecting five simple parameters (SpO2 ≤ 90%, tachypnoea, hypotension, advanced disease at chest radiography and tachycardia). This model predicted early mortality with a positive predictive value of 94.88% and a negative predictive value of 19.90%. Conclusions: The scoring system based on simple parameters may help to refer severely ill patients early to a higher level to reduce mortality, improve success rates, minimise the need for pulmonary rehabilitation and prevent post-treatment sequelae.

【 授权许可】

Unknown