Accuracy of Negative Tuberculin Skin Test in Predicting In-Hospital Tuberculosis Mortality

Pulm TB
Pulm TB
The relationship between negative tuberculin skin test and in-hospital mortality has not been previously studied.
This article is part of Infectious Disease Advisor’s coverage of IDWeek 2017™, taking place in San Diego, CA. Our on-site staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2017.

SAN DIEGO — Malnutrition, increasing age, and negative tuberculin skin test (TST) results are factors that may weaken the immune system and subsequently increase in-hospital mortality in hospitalized people with tuberculosis (TB), according to results from a retrospective study presented at IDWeek 2017.

Investigators retrospectively evaluated 961 hospitalized people with TB and assessed in-hospital mortality rates among those who received either a negative or positive TST result. A negative TST result was defined as less than 10 mm in duration. Researchers also evaluated associations among clinical and sociodemographic factors, TST, and in-hospital mortality.

According to the findings, 19.2% of patients had negative TST results. In addition, 2.9% of analyzed patients experienced in-hospital mortality. Characteristics of the patients who died with a negative TST result included a positive acid-fast bacilli smear (48.7%), foreign birth (47.9%), malnutrition (22.7%), homelessness (18.0%), TB history (16.7%), positive HIV diagnosis (2.5%), and multidrug-resistant TB (1.7%).

In total, only negative TST results, malnutrition, and age demonstrated a significant correlation with in-hospital mortality (all P <.005). Compared with patients with a positive TST, participants who had a negative TST result had a 2.2-fold higher risk for in-hospital death (95% CI, 1.1-4.2).

According to Dr Joo and colleagues, the findings reflect a possible “weakened cellular immune reaction to Mycobacterium tuberculosis antigens,” and the use of TST results may possess utility as a prognostic tool for identifying patients with a higher risk for mortality in the hospital setting.

Related Articles

Visit Infectious Disease Advisor’s conference section for continuous coverage live from IDWeek 2017.

Reference

Joo SJ, Kim J, Cegielski P. Risk factors associated with in-hospital mortality among patients with active TB disease: 25-year experience in the US. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Poster 2424.