TY - JOUR
T1 - Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa
AU - Mayosi, Bongani M.
AU - Wiysonge, Charles Shey
AU - Ntsekhe, Mpiko
AU - Gumedze, Freedom
AU - Volmink, Jimmy A.
AU - Maartens, Gary
AU - Aje, Akinyemi
AU - Thomas, Baby M.
AU - Thomas, Kandathil M.
AU - Awotedu, Abolade A.
AU - Thembela, Bongani
AU - Mntla, Phindile
AU - Maritz, Frans
AU - Blackett, Kathleen Ngu
AU - Nkouonlack, Duquesne C.
AU - Burch, Vanessa C.
AU - Rebe, Kevin
AU - Parrish, Andy
AU - Sliwa, Karen
AU - Vezi, Brian Z.
AU - Alam, Nowshad
AU - Brown, Basil G.
AU - Gould, Trevor
AU - Visser, Tim
AU - Magula, Nombulelo P.
AU - Commerford, Patrick J.
PY - 2008/1
Y1 - 2008/1
N2 - Objective. To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. Design. Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria and South Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. Results. We obtained the vital status of 174 (94%) patients (median age 33; range 14-87 years). The overall mortality rate was 26%. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40% v. 17%, p=0.001). Independent predictors of death during follow-up were: (i) a proven non-tuberculosis final diagnosis (hazard ratio (HR) 5.35, 95% confidence interval (CI) 1.76-16.25), (ii) the presence of clinical signs of HIV infection (HR 2.28, CI 1.14-4.56), (iii) coexistent pulmonary tuberculosis (HR 2.33, CI 1.20-4.54), and (iv) older age (HR 1.02, CI 1.01-1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80, CI 0.90-3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34, CI 0.10-1.19). Conclusion. A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africa. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease.
AB - Objective. To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. Design. Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria and South Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. Results. We obtained the vital status of 174 (94%) patients (median age 33; range 14-87 years). The overall mortality rate was 26%. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40% v. 17%, p=0.001). Independent predictors of death during follow-up were: (i) a proven non-tuberculosis final diagnosis (hazard ratio (HR) 5.35, 95% confidence interval (CI) 1.76-16.25), (ii) the presence of clinical signs of HIV infection (HR 2.28, CI 1.14-4.56), (iii) coexistent pulmonary tuberculosis (HR 2.33, CI 1.20-4.54), and (iv) older age (HR 1.02, CI 1.01-1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80, CI 0.90-3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34, CI 0.10-1.19). Conclusion. A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africa. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease.
UR - http://www.scopus.com/inward/record.url?scp=39749093269&partnerID=8YFLogxK
M3 - Article
C2 - 18270639
AN - SCOPUS:39749093269
SN - 0256-9574
VL - 98
SP - 36
EP - 40
JO - South African Medical Journal
JF - South African Medical Journal
IS - 1
ER -
