Miliary tuberculosis is a serious disease with a high mortality rate. Identification of patients at high risk for mortality can help guide more aggressive therapy. Early initiation of therapy once the diagnosis is suspected is important to ensure survival. The authors are from Groote Schuur Hospital and University of Cape Town, South Africa.
Patient population:
(1) 109 patients identified in period from 1978 to 1987
(2) 46 patients had predisposing factors (alcoholism, pregnancy, diabetes mellitus, steroid therapy, iron overload, hematologic malignancy, connective tissue disorder, other)
(3) The study was performed while AIDS was uncommon.
Independent risk factors for mortality by stepwise logistic regression:
(1) age
(2) lymphopenia
(3) thrombocytopenia
(4) hypoalbuminemia
(5) elevated transaminase levels
(6) treatment delay
Parameter |
Survivors (mean +/- SD) |
Died (mean +/- SD) |
age |
41.5 (+/- 16.3) |
50.8 +/- 15.3 |
lymphocyte count per µL |
870 (540 – 1,220) |
310 (190 – 490) |
platelet count per µL |
302,000 (+/- 155,000) |
181,000 (+/- 116,000) |
serum albumin in g/dL |
2.9 (2.5 – 3.2) |
2.2 (2.0 – 2.7) |
transaminase level, times upper limit of normal |
1 (1 – 2 ) |
2 (1 – 3) |
treatment delay in days |
1 (1 – 6) |
3 (1 – 6) |
after Table V, page 294
Prediction levels for poor prognosis:
(1) age > 60 years of age (stated in text)
(2) lymphopenia (< 540 per µL)
(3) thrombocytopenia (< 150,000 per µL)
(4) hypoalbuminemia (< 2.5 g/dL)
(5) elevated transaminase levels (> 2 times the upper limit of normal)
(6) treatment delay (>= 3 days)
Specialty: Infectious Diseases, Pulmonology
ICD-10: ,