A prediction rule to stratify mortality risk of patients with pulmonary tuberculosis

This study was conducted to develop an assessment tool to stratify mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were included in the model: hypoxemic respiratory failure (OR 4.7, 95%CI 2.8-7.9), ≥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 (OR 2.3, 95%CI 1.3-3.8) and hemoglobin <12 g/dL (OR 1.8, 95%CI 1.1-3.1). An assessment tool was developed, stratifying patients with low (score ≤2), moderate (score 3-5) and high (score ≥6) risk, with associated mortality 2.9%, 22.9% and 54%, 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.