ArticleAIDS research and therapy2018
Prognostic indicators in the World Health Organization's algorithm for seriously ill HIV-infected inpatients with suspected tuberculosis.
Article in AIDS research and therapy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- A systematic review of risk factors for mortality among tuberculosis patients in South Africa.Systematic reviews · 2023Pooled it
- Enhanced Tuberculosis Diagnosis With Computer-aided Chest X-ray and Urine Lipoarabinomannan in Adults With HIV Admitted to Hospital (CASTLE Study): A Cluster Randomized Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Predictive Factors for Progression to Severe Pulmonary Tuberculosis in Patients with Concurrent HIV/AIDS and Type 2 Diabetes Mellitus: A Single-Center Retrospective Study.Infection and drug resistance · 2026Article
- Narrative review of clinical prediction models for paediatric community acquired pneumonia.Paediatric respiratory reviews · 2025Review
- Sepsis in Northern Tanzania: A Prospective Observational Study of Clinical Characteristics, Management, and Outcomes for Adolescents and Adults With Sepsis.Open forum infectious diseases · 2025Article
- The therapeutic threshold in clinical decision-making for TB.International health · 2023Review
- Rifampicin resistance and mortality in patients hospitalised with HIV-associated tuberculosis.Southern African journal of HIV medicine · 2022Article
- Tuberculosis in Hospitalized Patients With Human Immunodeficiency Virus: Clinical Characteristics, Mortality, and Implications From the Rapid Urine-based Screening for Tuberculosis to Reduce AIDS Related Mortality in Hospitalized Patients in Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Impact of the implementation of new guidelines on the management of patients with HIV infection at an advanced HIV clinic in Kinshasa, Democratic Republic of Congo (DRC).BMC infectious diseases · 2020Article
- Early antituberculosis drug exposure in hospitalized patients with human immunodeficiency virus-associated tuberculosis.British journal of clinical pharmacology · 2020Article
- Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key.Journal of clinical tuberculosis and other mycobacterial diseases · 2020Article
- Clinical, microbiologic, and immunologic determinants of mortality in hospitalized patients with HIV-associated tuberculosis: A prospective cohort study.PLoS medicine · 2019Observational
- Current research toward optimizing dosing of first-line antituberculosis treatment.Expert review of anti-infective therapy · 2019Review
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6 authors at 1 institution in 1 country.
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Abstract
backgroundCriteria for the 2007 WHO algorithm for diagnosing tuberculosis among HIV-infected seriously ill patients are the presence of one or more danger signs (respiratory rate > 30/min, heart rate > 120/min, temperature > 39 °C, and being unable to walk unaided) and cough ≥ 14 days. Determining predictors of poor outcomes among HIV-infected inpatients presenting with WHO danger signs could result in improved treatment and diagnostic algorithms.
methodsWe conducted a prospective cohort study of inpatients presenting with any duration of cough and WHO danger signs to two regional hospitals in Cape Town, South Africa. The primary outcome was all-cause mortality up to 56 days post-discharge, and the secondary outcome a composite of any one of: hospital admission for > 7 days, died in hospital, transfer to a tertiary level or tuberculosis hospital. We first assessed the WHO danger signs as predictors of poor outcomes, then assessed the added value of other variables selected a priori for their ability to predict mortality in common respiratory opportunistic infections (CD4 count, body mass index (BMI), being on antiretroviral therapy (ART), hypotension, and confusion) by comparing the receiver operating characteristic (ROC) area under the curve (AUC) of the two multivariate models.
results484 participants were enrolled, median age 36, 66% women, 53% had tuberculosis confirmed on culture. The 56-day mortality was 13.2%. Inability to walk unaided, low BMI, low CD4 count, and being on ART were independently associated with poor outcomes. The multivariate model of the WHO danger signs showed a ROC AUC of 0.649 (95% CI 0.582-0.717) for predicting 56-day mortality, which improved to ROC AUC of 0.740 (95% CI 0.681-0.800; p = 0.004 for comparison between the two ROC AUCs) with the multivariate model including the a priori selected variables. Findings were similar in sub-analyses of participants with culture-positive tuberculosis and with cough duration ≥ 14 days.
conclusionThe study design prevented a rigorous evaluation of the prognostic value of the WHO danger signs. Our prognostic model could result in improved algorithms, but needs to be validated.
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