title: Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa.
abstract: 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.
authors.affiliation: Department of Medicine, University of Cape Town. bongani.mayosi@uct.ac.za
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.forename: Charles Shey
authors.initials: CS
authors.lastname: Wiysonge
authors.forename: Mpiko
authors.initials: M
authors.lastname: Ntsekhe
authors.forename: Freedom
authors.initials: F
authors.lastname: Gumedze
authors.forename: Jimmy A
authors.initials: JA
authors.lastname: Volmink
authors.forename: Gary
authors.initials: G
authors.lastname: Maartens
authors.forename: Akinyemi
authors.initials: A
authors.lastname: Aje
authors.forename: Baby M
authors.initials: BM
authors.lastname: Thomas
authors.forename: Kandathil M
authors.initials: KM
authors.lastname: Thomas
authors.forename: Abolade A
authors.initials: AA
authors.lastname: Awotedu
authors.forename: Bongani
authors.initials: B
authors.lastname: Thembela
authors.forename: Phindile
authors.initials: P
authors.lastname: Mntla
authors.forename: Frans
authors.initials: F
authors.lastname: Maritz
authors.forename: Kathleen Ngu
authors.initials: KN
authors.lastname: Blackett
authors.forename: Duquesne C
authors.initials: DC
authors.lastname: Nkouonlack
authors.forename: Vanessa C
authors.initials: VC
authors.lastname: Burch
authors.forename: Kevin
authors.initials: K
authors.lastname: Rebe
authors.forename: Andy
authors.initials: A
authors.lastname: Parrish
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.forename: Brian Z
authors.initials: BZ
authors.lastname: Vezi
authors.forename: Nowshad
authors.initials: N
authors.lastname: Alam
authors.forename: Basil G
authors.initials: BG
authors.lastname: Brown
authors.forename: Trevor
authors.initials: T
authors.lastname: Gould
authors.forename: Tim
authors.initials: T
authors.lastname: Visser
authors.forename: Nombulelo P
authors.initials: NP
authors.lastname: Magula
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Commerford
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents