title: Assessing tuberculosis case fatality ratio: a meta-analysis.
abstract: BACKGROUND
  Recently, the tuberculosis (TB) Task Force Impact Measurement acknowledged the need to review the assumptions underlying the TB mortality estimates published annually by the World Health Organization (WHO). TB mortality is indirectly measured by multiplying estimated TB incidence with estimated case fatality ratio (CFR). We conducted a meta-analysis to estimate the TB case fatality ratio in TB patients having initiated TB treatment.
  
  
  METHODS
  We searched for eligible studies in the PubMed and Embase databases through March 4(th) 2011 and by reference listing of relevant review articles. Main analyses included the estimation of the pooled percentages of: a) TB patients dying due to TB after having initiated TB treatment and b) TB patients dying during TB treatment. Pooled percentages were estimated using random effects regression models on the combined patient population from all studies.
  
  
  RESULTS
  We identified 69 relevant studies of which 22 provided data on mortality due to TB and 59 provided data on mortality during TB treatment. Among HIV infected persons the pooled percentage of TB patients dying due to TB was 9.2% (95% Confidence Interval (CI): 3.7%-14.7%) and among HIV uninfected persons 3.0% (95% CI: -1.2%-7.4%) based on the results of eight and three studies respectively providing data for this analyses. The pooled percentage of TB patients dying during TB treatment was 18.8% (95% CI: 14.8%-22.8%) among HIV infected patients and 3.5% (95% CI: 2.0%-4.92%) among HIV uninfected patients based on the results of 27 and 19 studies respectively.
  
  
  CONCLUSIONS
  The results of the literature review are useful in generating prior distributions of CFR in countries with vital registration systems and have contributed towards revised estimates of TB mortality This literature review did not provide us with all data needed for a valid estimation of TB CFR in TB patients initiating TB treatment.
authors: Unit Knowledge, Research and Policy, KNCV Tuberculosis Foundation, The Hague, The Netherlands. m.straetemans@kit.nl
authors: Masja
authors: M
authors: Straetemans
authors: Philippe
authors: P
authors: Glaziou
authors: Ana L
authors: AL
authors: Bierrenbach
authors: Charalambos
authors: C
authors: Sismanidis
authors: Marieke J
authors: MJ
authors: van der Werf
mesh_terms: D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D014376:Tuberculosis / Q000453:epidemiology / Q000401:mortality*