Prognostic score to predict mortality during TB treatment in TB/HIV co-infected patients

Abstract

BackgroundEstimating mortality risk during TB treatment in HIV co-infected patients is challenging for health professionals, especially in a low TB prevalence population, due to the lack of a standardized prognostic system. The current study aimed to develop and validate a simple mortality prognostic scoring system for TB/HIV co-infected patients.MethodsUsing data from the CDC’s Tuberculosis Genotyping Information Management System of TB patients in Texas reported from 01/2010 through 12/2016, age ≥15 years, HIV(+), and outcome being “completed” or “died”, we developed and internally validated a mortality prognostic score using multiple logistic regression. Model discrimination was determined by the area under the receiver operating characteristic (ROC) curve (AUC). The model’s good calibration was determined by a non-significant Hosmer-Lemeshow’s goodness of fit test.ResultsAmong the 450 patients included in the analysis, 57 (12.7%) died during TB treatment. The final prognostic score used six characteristics (age, residence in long-term care facility, meningeal TB, chest x-ray, culture positive, and culture not converted/unknown), which are routinely collected by TB programs. Prognostic scores were categorized into three groups that predicted mortality: low-risk (<20 points), medium-risk (20–25 points) and high-risk (>25 points). The model had good discrimination and calibration (AUC = 0.82; 0.80 in bootstrap validation), and a non-significant Hosmer-Lemeshow test p = 0.71.ConclusionOur simple validated mortality prognostic scoring system can be a practical tool for health professionals in identifying TB/HIV co-infected patients with high mortality risk.

&nbsp;Tuberculosis Treatment Outcome In Patients With Tb-Hiv Co-Infection In Kuala Lumpur, Malaysia

“…Nevertheless, this condition can also be due to the non-specific symptoms and broad-spectrum immune response among patients with TB-HIV, which may produce false negative sputum smear results among such patients(31-35). These findings were concordant with that of Nguyen et al and Nik Nor Ronaidi et al (16,19). Others have however showed that positive sputum smear is significantly associated with unsuccessful TB treatment outcome (1,29).…”

“…TB infection with late presentation and HIV diagnosis are further risk factors for unsuccessful TB treatment outcome among patients with TB-HIV (13)(14)(15). Other than that, patients with positive sputum culture upon TB diagnosis are at higher risk for unsuccessful TB treatment outcome (16).…”

Tuberculosis Treatment Outcome in Patients with Tb-hiv Co-infection in Kuala Lumpur, Malaysia

“…Nevertheless, this condition can also be due to the non-specific symptoms and broadspectrum immune response among patients with TB-HIV co-infection, which may produce false negative sputum smear results among such patients [24,[39][40][41][42]. These findings were concordant with that of Nguyen et al and Nik Nor Ronaidi et al [19,27]. Others have however showed that positive sputum smear is significantly associated with unsuccessful TB treatment outcome [1,37].…”

“…In this study, positive sputum culture upon diagnosis was significantly associated with unsuccessful TB treatment outcome. This finding was supported by similar findings by Prado et al, Nguyen et al and Swaminathan et al [1,19,32]. Patients with TB-HIV co-infection with positive sputum culture may have higher TB bacterial loads, which may thus worsen the prognosis.…”

“…TB infection with late presentation and HIV diagnosis are further risk factors for unsuccessful TB treatment outcome among patients with TB-HIV co-infection [16][17][18]. Other than that, patients with positive sputum culture upon TB diagnosis are at higher risk for unsuccessful TB treatment outcome [19].…”