Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa.
OBJECTIVE
To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa.


METHODS
Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria and South Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up.


RESULTS
We obtained the vital status of 174 (94%) patients (median age 33; range 14 - 87 years). The overall mortality rate was 26%. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40% v. 17%, p=0.001). Independent predictors of death during followup were: (i) a proven non-tuberculosis final diagnosis (hazard ratio (HR) 5.35, 95% confidence interval (CI) 1.76 - 16.25), (ii) the presence of clinical signs of HIV infection (HR 2.28, CI 1.14 - 4.56), (iii) coexistent pulmonary tuberculosis (HR 2.33, CI 1.20 - 4.54), and (iv) older age (HR 1.02, CI 1.01 - 1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80, CI 0.90 - 3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34, CI 0.10 - 1.19).


CONCLUSIONS
A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africa. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease.
Mayosi
Bongani M
BM
Department of Medicine, University of Cape Town. bongani.mayosi@uct.ac.za
Wiysonge
Charles Shey
CS
Ntsekhe
Mpiko
M
Gumedze
Freedom
F
Volmink
Jimmy A
JA
Maartens
Gary
G
Aje
Akinyemi
A
Thomas
Baby M
BM
Thomas
Kandathil M
KM
Awotedu
Abolade A
AA
Thembela
Bongani
B
Mntla
Phindile
P
Maritz
Frans
F
Blackett
Kathleen Ngu
KN
Nkouonlack
Duquesne C
DC
Burch
Vanessa C
VC
Rebe
Kevin
K
Parrish
Andy
A
Sliwa
Karen
K
Vezi
Brian Z
BZ
Alam
Nowshad
N
Brown
Basil G
BG
Gould
Trevor
T
Visser
Tim
T
Magula
Nombulelo P
NP
Commerford
Patrick J
PJ
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis / Q000379:methods; D010495:Pericarditis, Tuberculous / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
D000995:Antitubercular Agents