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

Mayosi, Bongani M.
Wiysonge, Charles Shey
Ntsekhe, Mpiko
Gumedze, Freedom
Volmink, Jimmy A.
Maartens, Gary
Aje, Akinyemi
Thomas, Baby M.
Thomas, Kandathil M.
Awotedu, Abolade A.
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Health and Medical Publishing Group (HMPG)
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.
EMTREE drug terms: antiretrovirus agent; corticosteroid derivative; tuberculostatic agent EMTREE medical terms: adolescent; adult; age distribution; aged; article; Cameroon; clinical feature; controlled study; female; follow up; heart tamponade; human; Human immunodeficiency virus infection; lung tuberculosis; major clinical study; male; mortality; Nigeria; patient care; patient referral; pericardiocentesis; pericarditis; prediction; proportional hazards model; South Africa; treatment outcome; vital sign MeSH: Adolescent; Adult; Africa South of the Sahara; Aged; Aged, 80 and over; Antitubercular Agents; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Kaplan-Meiers Estimate; Male; Middle Aged; Pericardiocentesis; Pericarditis, Tuberculous; Prognosis; Proportional Hazards Models; Prospective Studies; Survival Rate Medline is the source for the MeSH terms of this document., Lung tuberculosis -- Africa -- Sub-Saharan, Pericarditis -- Treatment -- Africa -- Sub-Saharan
Mayosi, BM, Wiysonge, CS, Ntsekhe, M, Gumedze, F, Volmink, JA, Maartens, G, Aje, A, Thomas, BM, Thomas, KM, Awotedu, AA, Thembela, B, Mntla, P, Maritz, F, Blackett, KN, Nkouonlack, DC, Burch, VC, Rebe, K, Parrish, A, Sliwa, K, Vezi, BZ, Alam, N, Brown, BG, Gould, T, Visser, T, Magula, NP & Commerford, PJ 2008, 'Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa', South African Medical Journal, vol. 98, no. 1, pp. 36-40.