Development of Pulmonary Tuberculosis screening tool (CEAMS-65 score) for predicting mortality rate in Pulmonary Tuberculosis patients

Abstract

Background:   Tuberculosis is an important infectious disease. The World Health Organization lists Thailand as one of the 30 countries with the highest rate of death from tuberculosis. Therefore, a National Tuberculosis Strategic Plan 2017 to 2021 was proposed to address the problem of the rising TB death rate in Thailand that should be resolved urgently.

Objective:      To study the relationship between factors related to death of new case pulmonary tuberculosis patients in Phrae Hospital and development screening tool for predicting mortality rate in new case Pulmonary Tuberculosis patients

Study design: A retrospective cohort study conducted at a tuberculosis clinic from January 2017 to October 2021 in Phrae Hospital. Factors included in the study were age, sex, weight, comorbidities, serum albumin levels, lesions from chest X-ray and sputum AFB. Chi-square test (p<0.05) was used to compare factors associated with death of patients during pulmonary tuberculosis treatment and Multiple logistic regression analysis was used to determine the factors that predict the death of patients during pulmonary tuberculosis treatment.

Results:         396 cases of pulmonary tuberculosis, of which 72 patients died during treatment (18.18%). It was found that the factors associated with mortality in pulmonary tuberculosis patients were statistically significant (p-value <0.05) as follows : older than 65 years (Odds ratio 3.49; 95% CI 2.08-5.89; p<0.001), patients with COPD (Odds ratio 4.14; 95% CI 1.08-15.82; p=0.038, serum albumin was less than 1.5 g/dL (Odds ratio 20.44; 95% CI 5.54-75.39; p<0.001), chest X-ray showed pleural fluid (Odds ratio 2.28; 95% CI 1.23-4.22; p=0.009), and chest X-ray showed Miliary tuberculosis (Odds ratio 3.84; 95% CI 1.18-12.45; p=0.025).

Conclusion:   New case pulmonary tuberculosis patients assessed as having a high risk of death risk score. (Score ≥5) should be closely monitored, have been taken care of in the hospital, consult a nutritionist, Follow up on blood results every week to prevent death during treatment.

Keywords:      Tuberculosis, Death, Risk factor, Predicting mortality rate