Development and validation of a tuberculosis prognostic score for smear-positive in-patients in Japan

Horita, Nobuyuki; Miyazawa, Noriko; Yoshiyama, Takashi; Sato, Takashi; Yamamoto, Masaki; Tomaru, Koichi; Masuda, Masashi; Tashiro, Kunio; Sasaki, Mitsuhito; Morita, Sojiro; Kaneko, Takeshi; Ishigatsubo, Y.

doi:10.5588/ijtld.12.0476

Cited by 35 publications

(45 citation statements)

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“…In the above mentioned study, the in-hospital mortality rate of the RA patients was similar to that of the non-RA patients (5), as also observed in the present study. In this study, RA itself was not found to be an independent risk factor contributing to in-hospital mortality, whereas several factors previously been reported to be prognostic factors (19)(20)(21) were found to be independent prognostic factors. Death from tuberculosis frequently occurs within one to three months after the development of the disease (6) and also occurs in RA patients.…”

Section: Discussioncontrasting

confidence: 77%

Characteristics of Tuberculosis in Patients with Rheumatoid Arthritis: A Retrospective Single-center Study

Ishiguro¹,

Takayanagi²,

Kagiyama³

et al. 2014

Intern. Med.

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Section: Discussioncontrasting

confidence: 77%

Characteristics of Tuberculosis in Patients with Rheumatoid Arthritis: A Retrospective Single-center Study

Ishiguro¹,

Takayanagi²,

Kagiyama³

et al. 2014

Intern. Med.

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“…Pakistan ranks among countries with both a high burden of TB and MDR-TB and encounters a high mortality rate from TB [2]. Efforts have been made in the past to analyze the causes of high mortality in TB patients and for their poor prognosis [14–18], especially in hospitalized patients [12, 19, 20]. HIV and other immunocompromised status [21], MDR-TB [22], late referrals [23], and increased age of patients [24] have been implicated, but these factors can vary regionally.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Tuberculosis Related Mortalities in Hospitalized Patients

Haque

Kumar

Saifuddin

et al. 2014

Tuberculosis Research and Treatment

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Setting. The study was undertaken at the Department of Pulmonology at a public, tertiary care centre in Karachi, Pakistan. Objectives. To evaluate factors concerned with in-hospital deaths in patients admitted with pulmonary tuberculosis (TB). Design. A retrospective case-control audit was performed for 120 patients hospitalised with pulmonary TB. Sixty of those discharged after treatment were compared to sixty who did not survive. Radiological findings, clinical indicators, and laboratory values were compared between the two groups to identify factors related to poor prognosis. Results. Factors concerned with in-hospital mortality listed late presentation of disease (P < 0.01), noncompliance to antituberculosis therapy (P < 0.01), smoking (P < 0.01), longer duration of illness prior to treatment (P < 0.01), and low body weight (P < 0.01). Most deaths occurred during the first week of admission (P < 0.01) indicating late referrals as significant. Immunocompromised status and multi-drug resistance were not implicated in higher mortality. Conclusions. Poor prognosis was associated with noncompliance to therapy resulting in longer duration of illness, late patient referrals to care centres, and development of complications. Early diagnosis, timely referrals, and monitored compliance may help reduce mortality. Adherence to a more radically effective treatment regimen is required to eliminate TB early during disease onset.

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“…Others are used on initially sputum smear-negative (SN) patients to improve and accelerate diagnosis of PTB (32–34). Few have tried to combine signs and symptoms into a CPR to screen for PTB (35–38) and only two CPRs to monitor TB treatment response have been proposed (16, 39). Horita et al (39) suggest a score consisting of age (in years), oxygen requirement, albumin concentration (g/dl), and activity of daily living.…”

Section: Introductionmentioning

confidence: 99%

The Bandim TBscore – reliability, further development, and evaluation of potential uses

Rudolf

2014

Global Health Action

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BackgroundThe tuberculosis (TB) case detection rate has stagnated at 60% due to disorganized case finding and insensitivity of sputum smear microscopy. Of the identified TB cases, 4% die while being treated, monitored with tools that insufficiently predict failure/mortality.ObjectiveTo explore the TBscore, a recently proposed clinical severity measure for pulmonary TB (PTB) patients, and to refine, validate, and investigate its place in case finding.DesignThe TBscore’s inter-observer agreement was assessed and compared to the Karnofsky Performance Score (KPS) (paper I). The TBscore’s variables underlying constructs were assessed, sorting out unrelated items, proposing a more easily assessable TBscoreII, which was validated internally and externally (paper II). Finally, TBscore and TBscoreII’s place in PTB-screening was examined in paper III.ResultsThe inter-observer variability when grading PTB patients into severity classes was moderate for both TBscore (κW=0.52, 95% CI 0.46–0.56) and KPS (κW=0.49, 95% CI 0.33–0.65). KPS was influenced by HIV status, whereas TBscore was unaffected by it. In paper II, proposed TBscoreII was validated internally, in Guinea-Bissau, and externally, in Ethiopia. In both settings, a failure to bring down the score by ≥25% from baseline to 2 months of treatment predicted subsequent failure (p=0.007). Finally, in paper III, TBscore and TBscoreII were assessed in health-care-seeking adults and found to be higher in PTB-diagnosed patients, 4.9 (95% CI 4.6–5.2) and 3.9 (95% CI 3.8–4.0), respectively, versus patients not diagnosed with PTB, 3.0 (95% CI 2.7–3.2) and 2.4 (95% CI 2.3–2.5), respectively. Had we referred only patients with cough >2 weeks to sputum smear, we would have missed 32.1% of the smear confirmed cases in our cohort. A TBscoreII>=2 missed 8.6%.ConclusionsTBscore and TBscoreII are useful monitoring tools for PTB patients on treatment, as they could fill the void which currently exists in risk grading of patients. They may also have a role in PTB screening; however, this requires our findings to be repeated elsewhere.

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Development and validation of a tuberculosis prognostic score for smear-positive in-patients in Japan

Abstract: In this study we were able to develop and validate a tuberculosis prognostic score.

Cited by 35 publications

References 0 publications

Characteristics of Tuberculosis in Patients with Rheumatoid Arthritis: A Retrospective Single-center Study

Characteristics of Tuberculosis in Patients with Rheumatoid Arthritis: A Retrospective Single-center Study

Prognostic Factors in Tuberculosis Related Mortalities in Hospitalized Patients

The Bandim TBscore – reliability, further development, and evaluation of potential uses

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