I N TRODUC T IONTuberculosis (TB) is the leading cause of morbidity and mortality due to a single infectious agent globally. In 2018, almost 10 million TB cases were reported as per WHO [1]. Worldwide, TB incidence is falling at a rate of about 2% per year. However, further efforts are needed to ramp it up to 4-5% annual decline and reach the end TB goal [1]. WHO
Background
Development of a prediction model using baseline characteristics of tuberculosis (TB) patients at the time of diagnosis will aid us in early identification of the high-risk groups and devise pertinent strategies accordingly. Hence, we did this study to develop a prognostic-scoring model for predicting the death among newly diagnosed drug sensitive pulmonary TB patients in South India.
Methods
We undertook a longitudinal analysis of cohort data under the Regional Prospective Observational Research for Tuberculosis India consortium. Multivariable cox regression using the stepwise backward elimination procedure was used to select variables for the model building and the nomogram-scoring system was developed with the final selected model.
Results
In total, 54 (4.6%) out of the 1181 patients had died during the 1-year follow-up period. The TB mortality rate was 0.20 per 1000 person-days. Eight variables (age, gender, functional limitation, anemia, leukopenia, thrombocytopenia, diabetes, neutrophil–lymphocyte ratio) were selected and a nomogram was built using these variables. The discriminatory power was 0.81 (95% confidence interval: 0.75–0.86) and this model was well-calibrated. Decision curve analysis showed that the model is beneficial at a threshold probability ~15–65%.
Conclusions
This scoring system could help the clinicians and policy makers to devise targeted interventions and in turn reduce the TB mortality in India.
Background
Tuberculosis (TB) is well-known for causing wasting. Patients on treatment gain weight and weight loss is associated with unfavorable treatment outcomes. There is limited description of weight loss and its predictors during intensive treatment phase. The objective of this study was to assess the predictors of weight loss during intensive phase and to see if there is any association exists with sputum conversion at the end of intensive phase of treatment.
Methods
Data collected as a part of the prospective TB cohort (Regional Prospective Observational Research for TB India Phase 1) conducted in Pondicherry, Cuddalore and Viluppuram districts of Tamil Nadu were used for this study. Sputum smear and body weight comparison were made in the baseline and at the end of second month of treatment.
Results
In all, 726 participants had weight measurements at the two time points and 18.7% had weight loss; mean weight lost being 2.3 kg (SD 3.05). Mean weight loss was more among males (2.4 kg, SD 3.2), diabetics (2.8 kg, SD 3.9) and alcoholics (2.1 kg, SD 2.4). Alcohol consumption was the only predictor of weight loss after adjusting for age, diabetes, marital status and BMI (aRR 1.52, P 0.02). Weight loss was not associated with sputum conversion at the end of second month.
Conclusions
Alcohol use emerged as the major predictor for weight loss during intensive phase.
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