Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa

Bongani M. Mayosi*, Charles Shey Wiysonge, Mpiko Ntsekhe, Freedom Gumedze, Jimmy A. Volmink, Gary Maartens, Akinyemi Aje, Baby M. Thomas, Kandathil M. Thomas, Abolade A. Awotedu, Bongani Thembela, Phindile Mntla, Frans Maritz, Kathleen Ngu Blackett, Duquesne C. Nkouonlack, Vanessa C. Burch, Kevin Rebe, Andy Parrish, Karen Sliwa, Brian Z. VeziNowshad Alam, Basil G. Brown, Trevor Gould, Tim Visser, Nombulelo P. Magula, Patrick J. Commerford

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

87 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)36-40
Number of pages5
JournalSouth African Medical Journal
Volume98
Issue number1
Publication statusPublished - Jan 2008
Externally publishedYes

Fingerprint

Dive into the research topics of 'Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa'. Together they form a unique fingerprint.

Cite this