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

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 (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/mm³) 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.

Keywords::

• Tuberculosis
• HIV
• TB score
• outcome
• mortality

Acknowledgement

The authors wish to thank Mr Tezera Jemere and Ms Saba Ekubay for their help in monitoring the TB patients at the DOTS centre. The authors are very grateful for the careful review of Dr Per Björkman of the Department of Infectious Diseases in Malmö, Skåne University Hospital, Sweden. This study was supported by the Swedish Heart and Lung Foundation and EU/EDCTP project JP 2009.10800.006.

Declaration of interest: The authors declare that they have no competing interests. This study was funded by the Swedish heart and lung Foundation (King Oscar II Jubilee Foundation) and EU/EDCP JP.10800.006.