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Early treatment response evaluated by a clinical scoring system correlates with the prognosis of pulmonary tuberculosis patients in Ethiopia: A prospective follow-up study.

Janols, Helena LU ; Abate, Ebba; Idh, Jonna; Senbeto, Meseret; Britton, Sven; Alemu, Shitaye; Aseffa, Abraham; Stendahl, Olle and Schön, Thomas (2012) In Scandinavian Journal of Infectious Diseases 44(11). p.828-834
Abstract
Background: In resource-limited settings the monitoring of tuberculosis (TB) patients is challenging, and early identification of TB patients with a high mortality risk is important. The aim of this study was to investigate prospectively whether early changes in a clinical scoring system (TB score) can predict treatment outcome in Ethiopian patients with pulmonary tuberculosis. Method: TB patients (n = 250) and blood donors (n = 82) were recruited prospectively at Gondar University Hospital, Ethiopia. Clinical scoring was performed using an interview-based questionnaire and clinical examination.



Results: Among TB patients (53.6% of whom were HIV co-infected) the median TB score declined from week 0 to week 2 (8... (More)
Background: In resource-limited settings the monitoring of tuberculosis (TB) patients is challenging, and early identification of TB patients with a high mortality risk is important. The aim of this study was to investigate prospectively whether early changes in a clinical scoring system (TB score) can predict treatment outcome in Ethiopian patients with pulmonary tuberculosis. Method: TB patients (n = 250) and blood donors (n = 82) were recruited prospectively at Gondar University Hospital, Ethiopia. Clinical scoring was performed using an interview-based questionnaire and clinical examination.



Results: Among TB patients (53.6% of whom were HIV co-infected) the median TB score declined from week 0 to week 2 (8 (interquartile range (IQR) 6-9) vs 4 (IQR 2-6)) and dropped to a low level at week 8, which was still significantly higher than that found in blood donors (2 (IQR 1-4) vs 0 (IQR 0-1), p < 0.0001). Patients who died had a significantly higher TB score at week 0, week 2, and week 8 than survivors. Mortality was associated with a failure to achieve a decrease greater than 25% in the TB score at 2 weeks. Baseline CD4 + cell counts (< 200 cells/mm(3)) were associated with mortality but not with initial TB score results. Conclusions: The TB score was increased during the first 2 months of treatment among patients who died. Failure to achieve a greater than 25% decrease in TB score after 2 weeks of treatment was associated with increased mortality. Repeated clinical scoring during the intensive phase of TB treatment could be useful to identify high-risk patients. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Infectious Diseases
volume
44
issue
11
pages
828 - 834
publisher
Informa Healthcare
external identifiers
  • WOS:000310008900004
  • PMID:22812387
  • Scopus:84867811482
ISSN
1651-1980
DOI
10.3109/00365548.2012.694468
language
English
LU publication?
yes
id
6e28d896-8f3b-4bbb-8822-5eade2a27693 (old id 2966900)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22812387?dopt=Abstract
date added to LUP
2012-08-09 20:24:50
date last changed
2016-10-13 04:34:19
@misc{6e28d896-8f3b-4bbb-8822-5eade2a27693,
  abstract     = {Background: In resource-limited settings the monitoring of tuberculosis (TB) patients is challenging, and early identification of TB patients with a high mortality risk is important. The aim of this study was to investigate prospectively whether early changes in a clinical scoring system (TB score) can predict treatment outcome in Ethiopian patients with pulmonary tuberculosis. Method: TB patients (n = 250) and blood donors (n = 82) were recruited prospectively at Gondar University Hospital, Ethiopia. Clinical scoring was performed using an interview-based questionnaire and clinical examination. <br/><br>
<br/><br>
Results: Among TB patients (53.6% of whom were HIV co-infected) the median TB score declined from week 0 to week 2 (8 (interquartile range (IQR) 6-9) vs 4 (IQR 2-6)) and dropped to a low level at week 8, which was still significantly higher than that found in blood donors (2 (IQR 1-4) vs 0 (IQR 0-1), p &lt; 0.0001). Patients who died had a significantly higher TB score at week 0, week 2, and week 8 than survivors. Mortality was associated with a failure to achieve a decrease greater than 25% in the TB score at 2 weeks. Baseline CD4 + cell counts (&lt; 200 cells/mm(3)) were associated with mortality but not with initial TB score results. Conclusions: The TB score was increased during the first 2 months of treatment among patients who died. Failure to achieve a greater than 25% decrease in TB score after 2 weeks of treatment was associated with increased mortality. Repeated clinical scoring during the intensive phase of TB treatment could be useful to identify high-risk patients.},
  author       = {Janols, Helena and Abate, Ebba and Idh, Jonna and Senbeto, Meseret and Britton, Sven and Alemu, Shitaye and Aseffa, Abraham and Stendahl, Olle and Schön, Thomas},
  issn         = {1651-1980},
  language     = {eng},
  number       = {11},
  pages        = {828--834},
  publisher    = {ARRAY(0x7bc1b68)},
  series       = {Scandinavian Journal of Infectious Diseases},
  title        = {Early treatment response evaluated by a clinical scoring system correlates with the prognosis of pulmonary tuberculosis patients in Ethiopia: A prospective follow-up study.},
  url          = {http://dx.doi.org/10.3109/00365548.2012.694468},
  volume       = {44},
  year         = {2012},
}