Horizon / Plein textes La base de ressources documentaires de l'IRD

IRD

 

Publications des scientifiques de l'IRD

Gupta-Wright A., Corbett E. L., Wilson D., van Oosterhout J. J., Dheda K., Huerga H., Peter J., Bonnet Maryline, Alufandika-Moyo M., Grint D., Lawn S. D., Fielding K. (2019). Risk score for predicting mortality including urine lipoarabinomannan detection in hospital inpatients with HIV-associated tuberculosis in sub-Saharan Africa : derivation and external validation cohort study. PLoS Medicine, 16 (4), e1002776 [20 p.]. ISSN 1549-1277

Fichier PDF disponiblehttp://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers19-05/010075658.pdf[ PDF Link ]

Lien direct chez l'éditeur doi:10.1371/journal.pmed.1002776

Titre
Risk score for predicting mortality including urine lipoarabinomannan detection in hospital inpatients with HIV-associated tuberculosis in sub-Saharan Africa : derivation and external validation cohort study
Année de publication2019
Type de documentArticle référencé dans le Web of Science WOS:000466741500003
AuteursGupta-Wright A., Corbett E. L., Wilson D., van Oosterhout J. J., Dheda K., Huerga H., Peter J., Bonnet Maryline, Alufandika-Moyo M., Grint D., Lawn S. D., Fielding K.
SourcePLoS Medicine, 2019, 16 (4), p. e1002776 [20 p.]. p. e1002776 [20 p.] ISSN 1549-1277
RésuméBackground The prevalence of and mortality from HIV-associated tuberculosis (HIV/TB) in hospital inpatients in Africa remains unacceptably high. Currently, there is a lack of tools to identify those at high risk of early mortality who may benefit from adjunctive interventions. We therefore aimed to develop and validate a simple clinical risk score to predict mortality in high-burden, low-resource settings. Methods and findings A cohort of HIV-positive adults with laboratory-confirmed TB from the STAMP TB screening trial (Malawi and South Africa) was used to derive a clinical risk score using multivariable predictive modelling, considering factors at hospital admission (including urine lipoarabinomannan [LAM] detection) thought to be associated with 2-month mortality. Performance was evaluated internally and then externally validated using independent cohorts from 2 other studies (LAM-RCT and a Medecins Sans Frontieres [MSF] cohort) from South Africa, Zambia, Zimbabwe, Tanzania, and Kenya. The derivation cohort included 315 patients enrolled from October 2015 and September 2017. Their median age was 36 years (IQR 30-43), 45.4% were female, median CD4 cell count at admission was 76 cells/l (IQR 23-206), and 80.2% (210/262) of those who knew they were HIV-positive at hospital admission were taking antiretroviral therapy (ART). Two-month mortality was 30% (94/315), and mortality was associated with the following factors included in the score: age 55 years or older, male sex, being ART experienced, having severe anaemia (haemoglobin < 80 g/l), being unable to walk unaided, and having a positive urinary Determine TB LAM Ag test (Alere). The score identified patients with a 46.4% (95% CI 37.8%-55.2%) mortality risk in the high-risk group compared to 12.5% (95% CI 5.7%-25.4%) in the low-risk group (p < 0.001). The odds ratio (OR) for mortality was 6.1 (95% CI 2.4-15.2) in high-risk patients compared to low-risk patients (p < 0.001). Discrimination (c-statistic 0.70, 95% CI 0.63-0.76) and calibration (Hosmer-Lemeshow statistic, p = 0.78) were good in the derivation cohort, and similar in the external validation cohort (complete cases n = 372, c-statistic 0.68 [95% CI 0.61-0.74]). The validation cohort included 644 patients between January 2013 and August 2015. Median age was 36 years, 48.9% were female, and median CD4 count at admission was 61 (IQR 21-145). OR for mortality was 5.3 (95% CI 2.2-9.5) for high compared to low-risk patients (complete cases n = 372, p < 0.001). The score also predicted patients at higher risk of death both pre- and post-discharge. A simplified score (any 3 or more of the predictors) performed equally well. The main limitations of the scores were their imperfect accuracy, the need for access to urine LAM testing, modest study size, and not measuring all potential predictors of mortality (e.g., tuberculosis drug resistance). Conclusions This risk score is capable of identifying patients who could benefit from enhanced clinical care, follow-up, and/or adjunctive interventions, although further prospective validation studies are necessary. Given the scale of HIV/TB morbidity and mortality in African hospitals, better prognostic tools along with interventions could contribute towards global targets to reduce tuberculosis mortality.
Plan de classementSanté : généralités [050] ; Entomologie médicale / Parasitologie / Virologie [052]
Descr. géo.AFRIQUE DU SUD ; ZAMBIE ; ZIMBABWE ; TANZANIE ; KENYA
LocalisationFonds IRD [F B010075658]
Identifiant IRDfdi:010075658
Lien permanenthttp://www.documentation.ird.fr/hor/fdi:010075658

Export des données

Disponibilité des documents

Télechargment fichier PDF téléchargeable

Lien sur le Web lien chez l'éditeur

Accès réservé en accès réservé

HAL en libre accès sur HAL


* PDF Link :

    à télécharger pour citer/partager ce document sur les réseaux sociaux académiques


Accès aux documents originaux :

Le FDI est labellisé CollEx

Accès direct

Bureau du chercheur

Site de la documentation

Espace intranet IST (accès réservé)

Suivi des publications IRD (accès réservé)

Mentions légales

Services Horizon

Poser une question

Consulter l'aide en ligne

Déposer une publication (accès réservé)

S'abonner au flux RSS

Voir les tableaux chronologiques et thématiques

Centres de documentation

Bondy

Montpellier (centre IRD)

Montpellier (MSE)

Cayenne

Nouméa

Papeete

Abidjan

Dakar

Niamey

Ouagadougou

Tunis

La Paz

Quito