title: A Prediction Rule to Stratify Mortality Risk of Patients with Pulmonary Tuberculosis.
abstract: Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8-7.9), age ≥50 years (OR 2.9, 95% CI 1.7-4.8), bilateral lung involvement (OR 2.5, 95% CI 1.4-4.4), ≥1 significant comorbidity-HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease-(OR 2.3, 95% CI 1.3-3.8), and hemoglobin <12 g/dL (OR 1.8, 95% CI 1.1-3.1). A tuberculosis risk assessment tool (TReAT) was developed, stratifying patients with low (score ≤2), moderate (score 3-5) and high (score ≥6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment.
authors.affiliation: Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.|Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.|ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Helder Novais
authors.identifier: http://orcid.org/0000-0002-1412-4202
authors.initials: HN
authors.lastname: Bastos
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.|ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Nuno S
authors.initials: NS
authors.lastname: Osório
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.|ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: António Gil
authors.initials: AG
authors.lastname: Castro
authors.affiliation: Department of Clinical Pathology, Centro Hospitalar São João, Porto, Portugal.|Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Angélica
authors.initials: A
authors.lastname: Ramos
authors.affiliation: Department of Clinical Pathology, Centro Hospitalar São João, Porto, Portugal.|Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Carvalho
authors.affiliation: Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Leonor
authors.initials: L
authors.lastname: Meira
authors.affiliation: Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.
authors.forename: David
authors.initials: D
authors.lastname: Araújo
authors.affiliation: Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Leonor
authors.initials: L
authors.lastname: Almeida
authors.affiliation: Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Boaventura
authors.affiliation: Department of Internal Medicine, Hospital do Santo Espírito da Ilha Terceira, Angra do Heroísmo, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Fragata
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Chaves
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.|ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.|Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal.
authors.forename: Patrício
authors.initials: P
authors.lastname: Costa
authors.affiliation: School of Economics and Management, University of Minho, Braga, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Portela
authors.affiliation: Department of Radiology, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Ivo
authors.initials: I
authors.lastname: Ferreira
authors.affiliation: Department of Radiology, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Sara Pinto
authors.initials: SP
authors.lastname: Magalhães
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.|ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodrigues
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.|ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.|Department of Infectious Diseases, Centro Hospitalar do Porto, Hospital Joaquim Urbano Unit, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Sarmento-Castro
authors.affiliation: Institute of Public Health, University of Porto, Porto, Portugal.|Department of Pneumology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.|Referral Centre for Multidrug-resistant tuberculosis in the Northern Region of Portugal, Chest Disease Centre of Vila Nova de Gaia, Vila Nova de Gaia, Portugal.|General Directorate of Health, Lisboa, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Duarte
authors.affiliation: Department of Clinical Pathology, Centro Hospitalar São João, Porto, Portugal.|Institute of Public Health, University of Porto, Porto, Portugal.|Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: João Tiago
authors.initials: JT
authors.lastname: Guimarães
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.|ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.|i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal.|IBMC - Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Saraiva
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000401:mortality*