title: Risk factors for in-hospital mortality among children with tuberculosis: the 25-year experience in Peru.
abstract: OBJECTIVE
  We examined factors associated with in-hospital death among children with tuberculosis (TB). We hypothesized that a negative response to tuberculin skin testing (TST) would predict decreased survival.
  
  
  METHODS
  This retrospective cohort comprised 2392 children ages 0 to 14 years hospitalized with TB at a Peruvian referral hospital over the 25-year study period. Detailed chart abstraction captured clinical history including TB contacts, physical examination findings, diagnostic data, treatment regimen, and hospitalization outcome. We used Cox proportional hazards regression analyses to determine risk factors for mortality.
  
  
  RESULTS
  Of 2392 children, 2 (0.1%) were known to be HIV-positive, 5 (0.2%) had documented multidrug-resistant TB, and 266 (11%) died. The median time from hospitalization to death was 16 days (interquartile range: 4-44 days). Reaction of <5 mm induration on TST predicted death in a multivariable analysis (hazard ratio [HR]: 3.01; 95% confidence interval [CI]: 2.15-4.21; P < .0001). Younger age, period of admission, alteration of mental status (HR: 3.25; 95% CI: 2.48-4.27; P < .0001), respiratory distress (HR: 1.40; 95% CI: 1.07-1.83; P = .01), peripheral edema (HR: 1.97; 95% CI: 1.42-2.73; P < .0001), and hemoptysis (HR: 0.57; 95% CI: 0.32-1.00; P = .05) were associated with mortality. Treatment regimens that contained rifampicin (HR: 0.47; 95% CI: 0.33-0.68; P < .0001) were associated with improved survival.
  
  
  CONCLUSIONS
  Negative reaction to TST is highly predictive of death among children with active TB. In children with clinical and radiographic findings suggestive of TB, a negative TST should not preclude or delay anti-TB therapy.
authors: Partners In Health, Boston, Massachusetts 02115, USA. pdrobac@pih.org
authors: Peter C
authors: PC
authors: Drobac
authors: Sonya S
authors: SS
authors: Shin
authors: Pedro
authors: P
authors: Huamani
authors: Sidney
authors: S
authors: Atwood
authors: Jennifer
authors: J
authors: Furin
authors: Molly F
authors: MF
authors: Franke
authors: Charmaine
authors: C
authors: Lastimoso
authors: Hernan
authors: H
authors: del Castillo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000401:mortality; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003906:Developing Countries; D019353:Endemic Diseases; D005188:False Negative Reactions; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D010568:Peru; D011379:Prognosis; D016016:Proportional Hazards Models; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000401:mortality*