Factors associated with mortality in extrapulmonary tuberculosis patients at a teaching hospital in Ghana

Abstract

SUMMARYObjectives: To investigate the clinical manifestations and factors associated with mortality in patients with extrapulmonary tuberculosis (EPTB) at the Korle-Bu Teaching Hospital Chest Clinic in Accra, Ghana. Design: We conducted a retrospective chart review of patients treated for EPTB at the Chest Clinic between January 1, 2009 and December 31, 2011. Patients with a new diagnosis of EPTB without concomitant pulmonary disease, aged 18 years or older, and who were treated at the Chest Clinic were eligible for participation in the study. Relevant data were abstracted from medical records and entered into a database. The factors associated with mortality were examined using bivariate and multivariate analysis. Results: Of the 157 patients in the study, the most affected age group was 25-34 years old (33.1%), 57.3% were male, and 71 (55.5%) of the 128 patients tested for HIV were sero-positive. Overall, 62 (39.5%) died during EPTB treatment. Mortality was associated with disseminated TB (AOR 149.85; P < 0.001), TB meningitis (AOR 79.14; P < 0.001), abdominal TB (AOR 23.59; P = 0.011), pleural effusion (AOR 12.6; P = 0.021) and age (AOR 1.05; P = 0.021). Among HIV co-infected patients, early initiation of ART reduced mortality rate. Conclusions: The site of EPTB was a key determinant of mortality. Given that death occurs soon after diagnosis, patients with suspected TB meningitis, disseminated, abdominal and pleural TB should be targeted for early diagnosis and treatment to reduce the high EPTB mortality in our setting.

Extra-pulmonary tuberculosis: A retrospective study of patients in Accra, Ghana

“…Disseminated TB is a severe form of EPTB usually associated with HIV infection with progression linked to the immuno-suppression and delayed treatment [29]. Given the HIV coinfection in our study population and with disseminated TB presenting with systemic symptoms, it is possible that delayed diagnosis may have contributed to this magnitude of disseminated TB [6,12, 20].…”

“…In view of the peculiarities of EPTB including the atypical nature of presentation, understanding the epidemiology of EPTB in diverse settings is of interest given the relevance of EPTB to TB control [14]. Except for two teaching hospital setting studies on EPTB conducted in Ghana, studies on the EPTB in-country are limited [20,21]. The current study therefore sought to highlight the epidemiology of EPTB patients diagnosed from different categories of health facilities in Accra compared to pulmonary TB (PTB) patients and identify risk factors for mortality among EPTB patients.…”

Prevalence of extrapulmonary tuberculosis among people living with HIV/AIDS in sub-Saharan Africa: a systemic review and meta-analysis

“… 10 In Cameroon and Ghana, HIV co-infection with EPTB was 37.1% and 45.2%, respectively. 11 , 12 However, an estimate reported on the prevalence of EPTB among PLWHA was inconsistent and unclear.…”

Factors Associated with Mortality in Tuberculosis Patients at Debre Birhan Referral Hospital, Ethiopia: A Retrospective Study

“…As the immune system is suppressed, it leads to dissemination of TB to the other body organs which often carries a high risk of death and unfavorable prognosis [30]. Moreover, it might be due to drug mal-absorption among HIV patients 18] and delay in starting ART [31]. Additionally, previous studies conducted in different countries reported that mortality was high among patients who are not on ART [32][33][34] and those with low CD4 counts [23,24].…”

“…This might be due to delay in the diagnosis of EPTB or even missing the diagnosis completely [36]. Hence, EPTB patients will deteriorate more rapidly and have higher death rates as compared to pulmonary TB cases [31,37].…”