The impact of functional performance, HIV status, malnutrition, and clinical features on treatment outcomes of patients with pulmonary tuberculosis

Abstract

We studied the influence of functional performance, clinical features, state of nutrition and HIV status at diagnosis on the outcome results of patients with pulmonary tuberculosis at a Yirga Alem Hospital in south Ethiopia. In prospective study, we investigated by functional, clinical, and nutritional methods 239 consecutive patients with pulmonary tuberculosis. Two hundred out of 239 (83.7%) patients were unable to work (KPS=<70) at first presentation. HIV positive tuberculosis patients had lower KPS (mean (SD) 56.2 (21.9)) than HIV negative tuberculosis patients (66.1 (13.4)) (Mann-Whitney test, p<0.013). The poor functional performance was significantly correlated with malnutrition as measured by low body mass index, low arm circumference and low body weight. The 26 admitted patients had a mean KPS of 49 compared with 67 among the other patients (Mann-Whitney test, p<0.001).Five out of 26 (19.2%) hospitalized patients died compared with seven of 124 (5.6%) of patients treated at the outpatients department (Fisher's exact test, p=0.04). Patients who died had a lower KPS than the other patients (Mann-Whitney test, p=0.045). Clinical features such as diarrhoea, skin disorders, neuropsychiatric impairment, and low Mantoux reactivity were significantly associated with a bad outcome of treatment. Our study concludes that some clinical features influence outcome of treatment with tuberculosis patients. However, the KPS is a better predictor to measure the need of health care than the outcome of treatment.


(Ethiopian Journal of Health Development, 2000, 14(2): 177-182)