In-hospital mortality due to extrapulmonary tuberculosis according to clinical and ultrasound features in Chókwè District, Mozambique. Retrospective hospital-based cohort study (2016-2020)

Abstract

IntroductionIn resource-limited settings, point-of-care ultrasound (POCUS) has great potential to support the timely diagnosis of extrapulmonary tuberculosis (EPTB).ObjectivesWe aim to determine the in-hospital mortality due to EPTB according to clinical and ultrasound features and risk factors in newly diagnosed patients hospitalized for EPTB in Chókwè district, Mozambique.MethodsWe analyzed routinely collected data from paper medical files and electronic ultrasound records of EPTB in infected patients aged 15 years or older and admitted to Carmelo Hospital of Chókwè from 2016 to 2020. Kaplan-Meier survival curves and adjusted Cox regression analyses were used to model predictors of mortality and time to death.ResultsThe 390 included inpatients with EPTB and ultrasound data contributed a total of 6240 in-hospital person-days of observation. The overall mortality rate was 2.16 per 100 person-days. Adjusted Cox regression showed a higher risk of death in those with abdominal tenderness (adjusted hazard ratio [aHR] 1.61, 95% confidence interval [CI] 1.00–2.82, p = 0.050), antiretroviral treatment (ART) for more than 90 days (aHR 4.03, 95% CI 1.50–10.78, p = 0.006), and mixed patterns on kidney ultrasound (aHR 2.91, 95% CI 1.38–6.10, p = 0.005). An optimal immunovirological response to ART was a protective factor against death [aHR] 0.12, 95% CI 0.04–0.35, p < 0.001).ConclusionVariables associated with an increased risk of death were male sex, abdominal pain, ART for more than three months (with immunovirological failure or non-response to ART) and having a mixed pattern of kidney ultrasound characteristics. Early detection of these risk factors may have a direct impact on reducing TB mortality, and the POCUS approach to diagnosing EPTB provides a simple, feasible and affordable intervention in resource-limited settings like Mozambique.